Thrombotic complications and other sequelae of heparin-induced thrombocytopenia (HIT).
| Complication of HIT . | Comment . |
|---|---|
| Abbreviations: DVT, deep vein thrombosis; INR, international normalized ratio. | |
| Venous thrombosis | Venous thrombosis predominates except in patient populations with arteriopathy (e.g., postcardiac or vascular surgery) |
| Lower-limb DVT | Most common thrombotic complication of HIT |
| Upper-limb DVT | Associated with use of upper-limb catheters |
| Pulmonary embolism | Possibly the most common cause of HIT-associated mortality |
| Adrenal vein thrombosis | Associated with adrenal hemorrhagic necrosis |
| Arterial thrombosis | Lower-limb arteries > cerebral arteries > coronary arteries (reverse of usual atherothrombosis) |
| Intracardiac thrombosis | Intraatrial and intraventricular thrombi can occur |
| Microvascular thrombosis | Less common than large vessel thrombosis |
| Venous limb gangrene | Associated with coumarin therapy, especially in setting of DVT and supratherapeutic INR (> 3.5) |
| Classic coumarin-induced skin necrosis | Less common in HIT than venous limb gangrene |
| Disseminated intravascular coagulation | Low fibrinogen occurs in 5%–10% of HIT patients and may rarely be associated with microvascular thrombosis |
| Acute systemic reaction postintravenous heparin bolus | Acute inflammatory (fever, chills), cardiorespiratory (chest pain, dyspnea, cardiac/respiratory arrest), and neurologic (headache, transient global amnesia) symptoms and signs that begin 5–30 min after intravenous heparin bolus |
| Skin lesions | Erythematous or necrotic lesions at heparin injection sites |
| Complication of HIT . | Comment . |
|---|---|
| Abbreviations: DVT, deep vein thrombosis; INR, international normalized ratio. | |
| Venous thrombosis | Venous thrombosis predominates except in patient populations with arteriopathy (e.g., postcardiac or vascular surgery) |
| Lower-limb DVT | Most common thrombotic complication of HIT |
| Upper-limb DVT | Associated with use of upper-limb catheters |
| Pulmonary embolism | Possibly the most common cause of HIT-associated mortality |
| Adrenal vein thrombosis | Associated with adrenal hemorrhagic necrosis |
| Arterial thrombosis | Lower-limb arteries > cerebral arteries > coronary arteries (reverse of usual atherothrombosis) |
| Intracardiac thrombosis | Intraatrial and intraventricular thrombi can occur |
| Microvascular thrombosis | Less common than large vessel thrombosis |
| Venous limb gangrene | Associated with coumarin therapy, especially in setting of DVT and supratherapeutic INR (> 3.5) |
| Classic coumarin-induced skin necrosis | Less common in HIT than venous limb gangrene |
| Disseminated intravascular coagulation | Low fibrinogen occurs in 5%–10% of HIT patients and may rarely be associated with microvascular thrombosis |
| Acute systemic reaction postintravenous heparin bolus | Acute inflammatory (fever, chills), cardiorespiratory (chest pain, dyspnea, cardiac/respiratory arrest), and neurologic (headache, transient global amnesia) symptoms and signs that begin 5–30 min after intravenous heparin bolus |
| Skin lesions | Erythematous or necrotic lesions at heparin injection sites |