Table 2.

Six treatment principles of heparin-induced thrombocytopenia (HIT).

* There are 2 reasons to give intravenous vitamin K when HIT is recognized after coumarin has been given. First, it may reduce the risk of coumarin-induced microthrombosis (venous limb gangrene and skin necrosis syndromes); second, it reduces the risk of underdosing of direct thrombin inhibitor therapy because of prolongation of the APTT by coumarin. 
Two Do’s

  • Stop heparin

  • Start alternative, non-heparin anticoagulant, usually in therapeutic doses

 
Two Don’ts

  • Avoid or postpone coumarin pending substantial platelet count recovery (give intravenous vitamin K if coumarin already given when HIT is recognized*)

  • Avoid platelet transfusions

 
Two Diagnostics

  • Test for HIT antibodies

  • Investigate for lower-limb DVT (duplex ultrasonography)

 
* There are 2 reasons to give intravenous vitamin K when HIT is recognized after coumarin has been given. First, it may reduce the risk of coumarin-induced microthrombosis (venous limb gangrene and skin necrosis syndromes); second, it reduces the risk of underdosing of direct thrombin inhibitor therapy because of prolongation of the APTT by coumarin. 
Two Do’s

  • Stop heparin

  • Start alternative, non-heparin anticoagulant, usually in therapeutic doses

 
Two Don’ts

  • Avoid or postpone coumarin pending substantial platelet count recovery (give intravenous vitamin K if coumarin already given when HIT is recognized*)

  • Avoid platelet transfusions

 
Two Diagnostics

  • Test for HIT antibodies

  • Investigate for lower-limb DVT (duplex ultrasonography)

 
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