Heparin induced thrombocytopenia thrombosis hitt syndrome. The adoption of low molecular weight heparins is one reason for the reduced incidence of. Treatment options for heparininduced thrombocytopenia. Management of heparininduced thrombocytopenia uptodate. Recommendations address screening of asymptomatic patients for hit, diagnosis and initial management of patients with suspected hit, treatment of acute hit. Feb 27, 2007 heparin is widely used for thromboprophylaxis or treatment in many clinical situations, including cardiovascular and orthopaedic surgery and invasive procedures, acute coronary syndromes, venous thromboembolism, atrial fibrillation, peripheral occlusive disease, dialysis, and during extracorporeal circulation. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called drug induced immune thrombocytopenia. Prophylaxis and treatment of heparininduced thrombocytopenia. The role of apixaban in the treatment of heparininduced thrombocytopenia. Heparin induced thrombocytopenia hit treatment page 2 of 7 disclaimer. Heparininduced thrombocytopenia hit is a serious complication of heparin therapy that has a high rate of morbidity thrombosis and amputation and mortality. Temporal aspects of heparininduced thrombocytopenia. Heparininduced thrombocytopenia hit is a clinicopathological syndrome that occurs when heparindependent, igg antibodies bind to heparinplatelet factor 4 pf4 complexes to activate platelets and produce a hypercoagulable state. Heparininduced thrombocytopenia circulation aha journals.
One third to onehalf of cases of hit are complicated by thrombosis, which may be limb or lifethreatening. For example, if you have heparin induced thrombocytopenia, your doctor can prescribe a different bloodthinning drug. Heparininduced thrombocytopenia hit is a prothrombotic adverse drug reaction. Apixaban for treatment of confirmed heparininduced. Heparininduced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to lowmolecular weight heparin. Heparininduced thrombocytopenia type i is harmless, causing a mild and transient reduction in platelet count. Heparininduced thrombocytopenia hit is an adverse reaction to the drug heparin resulting in an abnormally low amount of platelets thrombocytopenia. Treatment of hit involves immediate discontinuation of heparin and initiation of a parenteral nonheparin anticoagulant to treat. Heparin, a blood thinner, is the most common cause of druginduced immune thrombocytopenia. Hit predisposes to thrombosis the abnormal formation of blood clots inside a blood vessel because platelets release microparticles that activate thrombin, thereby leading to thrombosis. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information.
Heparininduced thrombocytopenia or hit is defined as the clinical condition where an individual under heparin treatment suffers from thrombocytopenia. Heparin is widely used for thromboprophylaxis or treatment in many clinical situations, including cardiovascular and orthopaedic surgery and invasive procedures, acute coronary syndromes, venous thromboembolism, atrial fibrillation, peripheral occlusive disease, dialysis, and during extracorporeal circulation. Heparininduced thrombocytopenia hit is a serious complication of heparin therapy that has a high rate of morbidity thrombosis and amputation and. Heparininduced thrombocytopenia hit is a lifethreatening complication of exposure to heparin ie, unfractionated heparin, low molecular weight lmw heparin that occurs in up to 5 percent of patients exposed, regardless of the dose, schedule, or route of administration. Heparininduced thrombocytopenia hit has three characteristic features that can distinguish it from other causes of thrombocytopenia. Heparininduced thrombocytopenia hit is a lifethreatening immune response to heparin and its derivatives that is associated with a high risk of thromboembolic complications. Jan 01, 2003 heparin induced thrombocytopenia hit is one of the most common and potentially devastating of immunemediated drug reactions. The byproduct of this interaction is thrombin formation which substantially increases the risk of venous andor arterial thromboembolism. American society of hematology 2018 guidelines for management. How i treat heparininduced thrombocytopenia and thrombosis. Two clinical forms of hit are generally recognized. Hit predisposes to thrombosis the abnormal formation of blood clots inside a blood vessel because platelets release microparticles that activate thrombin, thereby.
Heparininduced thrombocytopenia hit is an antibodymediated adverse drug reaction that can lead to devastating thromboembolic complications, including pulmonary embolism, ischemic limb necrosis necessitating limb amputation, acute myocardial infarction, and stroke. Heparininduced thrombocytopenia hit is a condition that causes a decrease of platelets in the blood. Temporal aspects of heparin induced thrombocytopenia. Thrombocytopenia is a serious condition in which patients have a low platelet count. Hit is usually an immune response which typically occurs 410 days after exposure to heparin. Heparininduced thrombocytopenia is a prothrombotic iatrogenic disorder induced by plateletactivating antibodies that target multimolecular complexes of platelet factor 4 and heparin. Heparin induced thrombocytopenia hit treatment page 1 of 7.
Diagnosis is essentially clinical and negative results of laboratory assays do not exclude the diagnosis. Heparininduced thrombocytopenia treatment algorithm bmj. Heparininduced thrombocytopenia hit is a rare but potentially severe complication of heparin therapy that is strongly associated with venous and arterial thrombosis hit and thrombosis syndrome, hitts, which requires urgent detection and treatment with a nonheparin anticoagulant. Heparininduced thrombocytopenia hit is a lifethreatening complication of exposure to heparin ie, unfractionated heparin, low molecular weight lmw heparin that occurs in up to 5 percent of patients exposed, regardless. Heparininduced thrombocytopenia hit is considered the most common form of druginduced thrombocytopenia as well as one of the common causes of thrombocytopenia in hospitalized patients. Highdose intravenous immunoglobulin ivig has been used as an adjunct to anticoagulation in patients with hit. Treatment and prevention of heparininduced thrombocytopenia.
Jul 14, 2017 heparin induced thrombocytopenia hit is a life and limbthreatening condition caused by the binding of plateletactivating antibodies igg to multimolecular platelet factor 4 pf4 heparin complexes because of heparin exposure. There are two types of druginduced thrombocytopenia. Apixaban for treatment of confirmed heparin induced thrombocytopenia. How i treat heparininduced thrombocytopenia blood american.
Heparininduced thrombocytopenia genetic and rare diseases. Heparin induced thrombocytopenia hit is the development of thrombocytopenia a low platelet count, due to the administration of various forms of heparin, an anticoagulant. Heparininduced thrombocytopenia rn continued education. Rii receptors on circulating platelets and induces platelet. What diagnostic studies are warranted, and how should this patient be treated. Heparininduced thrombocytopenia hit is one of the most common and potentially devastating of immunemediated drug reactions. The recommended treatment of hit patients with thrombosis is 15003750 u bolus depending on body weight followed by a 400 uh. May 03, 2012 heparin induced thrombocytopenia hit is an adverse reaction to the drug heparin resulting in an abnormally low amount of platelets thrombocytopenia. We can better understand the disease by knowing what are heparin and thrombocytopenia. There are two types of drug induced thrombocytopenia.
The following guideline is intended to guide the management of heparin induced thrombocytopenia and includes recommendations for diagnosis and treatment agents. Dec 12, 2019 treatment of heparin induced thrombocytopenia involves discontinuing heparin and starting a non heparin anticoagulant. Hit is a dangerous, potentially lethal, immunologicallymediated adverse drug reaction to unfractionated heparin ufh or, less commonly, low. However, not all thrombocytopenia is due to such system alterations. Heparin induced thrombocytopenia or hit is defined as the clinical condition where an individual under heparin treatment suffers from thrombocytopenia. Heparininduced thrombocytopenia inpatient care what.
Global heparininduced thrombocytopenia hit treatment market since the. First is the timing of the onset of thrombocytopenia. Treatment of hit involves immediate discontinuation of heparin and initiation of a parenteral nonheparin anticoagulant to treat andor prevent thrombotic. About heparininduced thrombocytopenia hit treatment market.
The principal choices for a nonheparin anticoagulant are the direct thrombin inhibitors dtis. Heparin induced thrombocytopenia thrombosis hitt is associated with a high morbidity and mortality. Heparin induced thrombocytopenia is a prothrombotic iatrogenic disorder induced by plateletactivating antibodies that target multimolecular complexes of platelet factor 4 and heparin. Hit syndrome heparininduced thrombocytopenia with thrombosis. Type 1 hit presents within the first 2 days after exposure to heparin, and the platelet. This is the case with heparininduced thrombocytopenia, or hit. Heparininduced thrombocytopenia what you need to know.
Heparininduced thrombocytopenia hit treatment market size. Heparininduced thrombocytopenia inpatient care what you. Antithrombotic therapy and prevention of thrombosis, 9th ed. If your thrombocytopenia is caused by an underlying condition or a medication, addressing that cause might cure it. May 05, 2020 about heparin induced thrombocytopenia hit treatment market. Heparininduced thrombocytopenia hit is a complication of heparin therapy. The first step is to discontinue heparin on suspicion of hit. Heparin induced thrombocytopenia adult inpatient clinical. Medical or obstetric patients receiving treatment doses or prophylactic heparin 4 days.
American college of chest physicians evidencebased clinical practice guidelines. Heparininduced thrombocytopenia hit is a complication of heparin therapy and is characterized by two types. Treatment involves stopping all heparin immediately and giving an alternative thrombin inhibitor. The treatment of hit requires stopping heparin treatment, and both protection from thrombosis and choice of an agent that will not. While the condition carries a high risk for morbidity and mortality, early detection and prompt treatment can greatly reduce the associated risk to life and limb.
Thrombocytopenia drug induced information mount sinai. Heparininduced thrombocytopenia hit is a life and limbthreatening condition caused by the binding of plateletactivating antibodies igg to multimolecular platelet factor 4 pf4heparin complexes because of heparin exposure. Heparininduced thrombocytopenia type ii hit is a more serious autoimmune disease causing a low platelet count and paradoxical blood clotting. The recommended treatment of hit patients with thrombosis is 15003750 u bolus depending on body weight followed by a 400. The next step is to treat hit using an alternative type of anticoagulant. The role of direct oral anticoagulants in the management. Heparininduced thrombocytopenia is a transient development of antibodies to heparin. Heparininduced thrombocytopenia symptoms, diagnosis and. American society of hematology 2018 guidelines for management of venous thromboembolism. Global heparin induced thrombocytopenia hit treatment market since the covid19 virus outbreak in. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called druginduced immune thrombocytopenia. The risk is higher with the use of unfractionated heparin, longer duration of therapy, and among surgical patients and elderly women.
American society of hematology guidelines suggest that some agents may be preferred in certain circumstances, as follows 54. Heparin induced thrombocytopenia hit is an immunemediated prothrombotic disorder characterized by the formation of plateletactivating immunoglobulin g against platelet factor 4 heparin complex. This report studies the heparininduced thrombocytopenia hit treatment market size value and volume by players, regions, product types and end industries, and forecast data 20202026. In the past, a number of different anticoagulants have been used to treat hit in an attempt to prevent these complications.
Dec 12, 2019 heparin induced thrombocytopenia hit has three characteristic features that can distinguish it from other causes of thrombocytopenia. Recent advances in the diagnosis and treatment of heparin induced thrombocytopenia. Heparin induced thrombocytopenia hit is a clinicopathological syndrome that occurs when heparin dependent, igg antibodies bind to heparin platelet factor 4 pf4 complexes to activate platelets and produce a hypercoagulable state. The role of apixaban in the treatment of heparin induced thrombocytopenia. Heparininduced thrombocytopenia hit, formerly hit type ii, is a prothrombotic and potentially lethal disorder caused by platelet, endothelial, and monocyte. Apixaban for treatment of confirmed heparininduced thrombocytopenia. Heparin induced thrombocytopenia hit is a prothrombotic adverse drug reaction. The role of direct oral anticoagulants in the management of. Heparininduced thrombocytopenia treatment algorithm. Heparininduced thrombocytopenia type ii occurs in 15% of patients started on heparin. Heparin induced thrombocytopenia hit is a lifethreatening complication of exposure to heparin ie, unfractionated heparin, low molecular weight lmw heparin that occurs in up to 5 percent of patients exposed, regardless of the dose, schedule, or route of administration. For people who do need treatment for thrombocytopenia, treatment depends on its cause and how severe it is.
Treatment and prevention of heparin induced thrombocytopenia. Heparin induced thrombocytopenia hit is an antibodymediated adverse drug reaction that can lead to devastating thromboembolic complications, including pulmonary embolism, ischemic limb necrosis necessitating limb amputation, acute myocardial infarction, and stroke. Target population adult patients with suspicion or diagnosis of heparin induced thrombocytopenia key practice recommendations screening for. Heparin induced thrombocytopenia hit is a serious complication of heparin therapy that has a high rate of morbidity thrombosis and amputation and mortality. An iv or central line that is flushed with heparin or coated with heparin. Heparin induced thrombocytopenia hit is a lifethreatening immune response to heparin and its derivatives that is associated with a high risk of thromboembolic complications.
Heparin induced thrombocytopenia hit is considered the most common form of drug induced thrombocytopenia as well as one of the common causes of thrombocytopenia in hospitalized patients. Aug 05, 2019 what is heparin induced thrombocytopenia. Hit usually occurs after you are treated with heparin. Global heparininduced thrombocytopenia hit treatment market since the covid19 virus outbreak in. Heparin, a blood thinner, is the most common cause of drug induced immune thrombocytopenia. Heparin induced thrombocytopenia hit is a complication of heparin therapy. The clinicopathological syndrome of heparininduced thrombocytopenia hit can present as isolated thrombocytopenia or in association with a thrombotic event. This is the case with heparin induced thrombocytopenia, or hit.
Heparin induced thrombocytopenia is a transient development of antibodies to heparin. A nonheparin anticoagulant should be initiated before the hit assay result is available even if the patient does not currently have thrombosis. Feb 03, 2020 heparin induced thrombocytopenia hit is a condition that causes a decrease of platelets in the blood. In most cases, treatment must be initiated based on a strong clinical suspicion of hit, even before confirmatory laboratory test results are. This can occur due to certain disease processes such as alterations in the immune system or with leukemia. Recent advances in the diagnosis and treatment of heparininduced thrombocytopenia. A non heparin anticoagulant should be initiated before the hit assay result is available even if the patient does not currently have thrombosis. Heparininduced thrombocytopenia hit is the development of thrombocytopenia a low platelet count, due to the administration of various forms of heparin, an anticoagulant. The clinicopathological syndrome of heparin induced thrombocytopenia hit can present as isolated thrombocytopenia or in association with a thrombotic event. Heparin induced thrombocytopenia hit is an immunemediated prothrombotic disorder characterized by the formation of plateletactivating immunoglobulin g against platelet factor 4heparin complex. Because the platelet count normalizes even with continued heparin therapy, it is not associated with increased thrombotic risk. Heparin refers to an anticoagulant medication which prevents blood clots from forming, and thrombocytopenia refers to decreased number of thrombocytes, or.
125 1324 104 386 407 619 242 403 223 845 697 485 1322 606 1218 461 137 246 407 966 1280 781 998 5 1171 353 174 1009 1345