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Medicine (MD/DO)
Heparin Induced Thrombocytopenia (HIT)

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Heparin Induced Thrombocytopenia (HIT)

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Heparin Induced Thrombocytopenia (HIT)

Hippie-heron HIT Trombone-side-toe-peanut
The most common cause of drug-induced thrombocytopenia with an incidence of 0.2 to 5.0% in patients who have been treated with heparin for greater than 4 days. Unfractionated heparin is more likely to cause HIT than Low Molecular Weight Heparin (LMWH).
5-10 Days After Heparin Exposure
Nickel and Dime drinks during Heparin Day

Thrombocytopenia (decreased platelets >50%) typically occurs 5-10 days following initiation of heparin. Early onset of HIT (within ~10.5 hours) may be seen in patients who have received heparin therapy recently with persistent antibodies to the complex of heparin and platelet factor 4.

Heparin-Platelet Factor 4 Complex
Hippie-heron with Plate and (4) Fork

Platelet Factor 4 is released from the alpha granules of platelets upon platelet activation and binds to heparin.

Autoantibodies Form Against Complex
Ant-tie-body Getting Defensive

IgG, IgA and IgM autoantibodies form against the Heparin-Platelet Factor 4 complex.

Heparin-Platelet Factor 4-Antibody Complex Binds Platelets
Hippie-heron with Plate (4) Fork and Ant-tie-body Binding to Plates

This process leads to a disease sequelae of platelet aggregation, thrombocytopenia and increasingly more procoagulant leading to thrombosis.

Platelet Aggregation
Sticky Plates

Heparin-Platelet Factor 4-antibody complex bound to platelets results in platelet aggregation and less available circulating platelets, creating thrombocytopenia.

Procoagulant Release

The platelet aggregation also results in the release of procoagulants which can cause thrombosis.


Platelets fall by >50%; however, the platelet count is usually still >20,000 platelets.

Serotonin Release Assay (SRA)
Silver-tonic Releasing SRA-tap

The Serotonin Release Assay (SRA) is the gold standard. The diagnosis of HIT is confirmed if high serotonin release occurs marking greater platelet activation. A CBC is always performed to determine the degree of thrombocytopenia.

Stop Heparin, Start Direct Thrombin Inhibitor
Red-light Hippie-heron, Green-light Direct-route Trombone Inhibitor

Heparin must be stopped immediately and a direct thrombin inhibitor, such as FDA approved argatroban or bivalrudin, is started. Other important agents to consider using include fondaparinux, danaparoid and apixaban/rivaroxaban.


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