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Treatment of HIT
High suspicion or confirmed HIT | |||||||||||||||||||
HIT with thrombosis | Isolated HIT | ||||||||||||||||||
❑ Perform a lower extremity U/S to R/O asymptomatic DVT[1] | |||||||||||||||||||
Presence of asymptomatic DVT | No DVT | ||||||||||||||||||
❑ Discontinue heparin ❑ Initiate non heparin anticoagulation for 3-6 months: - Argatroban (can be used in renal insufficiency) - Lepirudin - Danaparoid[1] | ❑ Discontinue heparin ❑ Initiate non heparin anticoagulation until platelets are back to normal:[1] - Argatroban (can be used in renal insufficiency) - Lepirudin - Danaparoid | ||||||||||||||||||
❑ Check if patient is/needs to be on VKA | |||||||||||||||||||
❑ Don't start VKA until the platelet count goes back to normal, after which initiate VKA at low doses ❑ When VKA is to be started, overlap it with non heparin anticoagulant for at least 5 days until INR is within the target range ❑ If VKAis started when patient is diagnosed with HIT, administer vitamin K[2] | |||||||||||||||||||
- ↑ 1.0 1.1 1.2 Cuker A, Cines DB (2012). "How I treat heparin-induced thrombocytopenia". Blood. 119 (10): 2209–18. doi:10.1182/blood-2011-11-376293. PMID 22246036.
- ↑ Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S; et al. (2012). "Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e495S–530S. doi:10.1378/chest.11-2303. PMC 3278058. PMID 22315270.