Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment

Alberio, Lorenzo (2008). Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment. Current opinion in hematology, 15(5), pp. 456-64. Hagerstown, Md.: Wolters Kluwer Lippincott Williams & Wilkins 10.1097/MOH.0b013e32830b84a2

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PURPOSE OF REVIEW: The present contribution will illustrate some evolving concepts on the pathogenesis and clinical management of heparin-induced thrombocytopenia (HIT) and describe how we approach patients with suspected HIT at our institution. RECENT FINDINGS: HIT is caused by an autoimmune reaction leading to the formation of antibodies directed against platelet factor 4. Conditions favoring the development of anti-platelet factor 4/heparin antibodies differ from those required for the formation of macromolecular ternary complexes (HIT antibody/platelet factor 4/heparin), which are able to activate platelets and induce clinical HIT. HIT can be diagnosed by combining its pretest probability with the quantitative result of rapid HIT-antibody assays. Treatment of acute HIT requires inhibition of in-vivo thrombin generation by means of alternative nonheparin anticoagulant drugs, whose effective dosage appears to be significantly lower than the official recommendations. As HIT antibodies are transient, HIT patients can be re-exposed to heparin, provided that previous heparin treatment is remote and that anti-platelet factor 4/heparin antibodies are undetectable. SUMMARY: In recent years, there has been a continuing elucidation of pathogenic and clinically relevant issues, which are intellectually rewarding to follow and should enable us to offer a steadily improving treatment to the HIT patients we are in charge of.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory

UniBE Contributor:

Alberio, Lorenzo

ISSN:

1065-6251

ISBN:

18695368

Publisher:

Wolters Kluwer Lippincott Williams & Wilkins

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:02

Last Modified:

04 May 2014 23:18

Publisher DOI:

10.1097/MOH.0b013e32830b84a2

PubMed ID:

18695368

Web of Science ID:

000259353500003

URI:

https://boris.unibe.ch/id/eprint/26904 (FactScience: 97180)

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