Heparin-induced thrombocytopenia without thrombosis: An evidence-based review of current literature

O' Connor, Enda D. and Fraser, John F. (2006) Heparin-induced thrombocytopenia without thrombosis: An evidence-based review of current literature. Critical Care and Resuscitation, 8 4: 345-352.

Author O' Connor, Enda D.
Fraser, John F.
Title Heparin-induced thrombocytopenia without thrombosis: An evidence-based review of current literature
Journal name Critical Care and Resuscitation   Check publisher's open access policy
ISSN 1441-2772
Publication date 2006-12
Year available 2006
Sub-type Article (original research)
Volume 8
Issue 4
Start page 345
End page 352
Total pages 8
Place of publication Melbourne, Australia
Publisher Australasian Academy of Critical Care Medicine
Language eng
Subject 1102 Cardiovascular Medicine and Haematology
11 Medical and Health Sciences
Formatted abstract
BACKGROUND AND AIM:
There has been a recent change in the management guidelines for patients with heparin-induced thrombocytopenia with the addition of a recommendation to commence parenteral anticoagulation in patients with isolated HIT without evidence of thrombosis. We assessed the evidence supporting this recommendation, to answer the following questions: in a patient with isolated HIT, should alternative anticoagulation be commenced, what alternative agent should be used, what is the recommended duration of anticoagulation, and when should warfarin be used?

METHODS:

We searched MEDLINE (using keywords 'heparin-induced thrombocytopenia', 'heparin induced thrombocytopaenia', 'HIT' and 'HITTS') and PubMed (using MeSH terms 'thrombocytopenia' and 'heparin') from 1966 to 2006 and selected articles for further assessment according to specified criteria.

RESULTS:
We assessed 12 non-randomised studies, five large case series and multiple small case series.

CONCLUSION:
Although patients with isolated HIT are at considerable risk of new thrombosis, there is limited evidence to support or reject the use of non-heparin anticoagulation in this group. Non-randomised, historically controlled trials support the use of lepirudin and argatroban; evidence favouring danaparoid is limited to large case series and one retrospective observational study. Duration of parenteral anticoagulation and warfarin use are guided by consensus opinion alone.
Keyword Anticoagulants
Therapeutic use
Heparin effects
Thrombocytopenia
Thrombosis
Drug therapy
Hirudin Therapy
Adverse effects
Thrombosis
Recombinant Proteins
Dermatan Sulfate
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Health and Behavioural Sciences -- Publications
Excellence in Research Australia (ERA) - Collection
 
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Created: Thu, 24 Dec 2009, 11:45:34 EST by Rosalind Blair on behalf of Faculty Of Health Sciences