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. 2023 Jun 22;7(5):100283. doi: 10.1016/j.rpth.2023.100283

Heparin-induced thrombocytopenia: An illustrated review

Jori May 1,∗, Brian Westbrook 1, Adam Cuker 2,3
PMCID: PMC10439402  PMID: 37601013

Abstract

Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug effect from unfractionated or low-molecular-weight heparin that results in thrombocytopenia and potentially catastrophic thrombosis. HIT occurs due to the development of platelet-activating antibodies against multimolecular complexes of platelet factor 4 and heparin. Given the frequency of thrombocytopenia and heparin use among hospitalized patients, calculation of the 4Ts Score is recommended to identify patients at increased likelihood of HIT and direct further evaluation. In patients with an intermediate or high probability 4Ts Score, an immunoassay and functional assay are recommended to confirm or refute the diagnosis of HIT. Heparin avoidance and initiation of nonheparin anticoagulation are the mainstays of acute HIT management. In this illustrated review, we provide visual summaries of the diagnosis and management of HIT, highlighting connections between pathophysiology and clinical care as well as summarizing efforts in quality improvement in the field. We further emphasize common pitfalls and pearls in diagnosis and management to encourage evidence-based care. We include graphical representation of the unique challenges of HIT with cardiopulmonary bypass and also delineate autoimmune HIT and its subtypes.

Keywords: anticoagulants, drug-related side effects and adverse reactions, heparin, quality improvement, thrombosis

Essentials

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    Heparin-induced thrombocytopenia (HIT) is an immune adverse drug effect that results in low platelets and risk of thrombosis.

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    Use of the 4Ts Score is recommended to assess patient risk of HIT.

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    Sequential specialized testing is required to diagnose HIT.

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    Heparin avoidance and use of nonheparin anticoagulation are the mainstays of HIT management.

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Acknowledgments

The authors thank Douglas Cines, MD, for his expert review of the manuscript. Illustrations created with BioRender.com.

Funding

The authors received no funding for this study.

Author contributions

J.M. conceptualized the manuscript and created the initial content and visualization. B.W. and A.C. provided critical review and revision.

Relationship disclosure

J.M. and B.W. report no relevant conflicts of interest. A.C. has served as a consultant for Synergy, MingSight, and the New York Blood Center and has received authorship royalties from UpToDate.

Footnotes

Handling Editor: Dr Michelle Sholzberg

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