Display options
Cite
Gupta S, Tiruvoipati R, Green C, et al. Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums. World J Crit Care Med. 2015;4(3):202-12doi: 10.5492/wjccm.v4.i3.202.
Gupta, S., Tiruvoipati, R., Green, C., Botha, J., & Tran, H. (2015). Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums. World journal of critical care medicine, 4(3), 202-12. https://doi.org/10.5492/wjccm.v4.i3.202
Gupta, Sachin, et al. "Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums." World journal of critical care medicine vol. 4,3 (2015): 202-12. doi: https://doi.org/10.5492/wjccm.v4.i3.202
Gupta S, Tiruvoipati R, Green C, Botha J, Tran H. Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums. World J Crit Care Med. 2015 Aug 04;4(3):202-12. doi: 10.5492/wjccm.v4.i3.202. eCollection 2015 Aug 04. PMID: 26261772; PMCID: PMC4524817.
Copy Download .nbib Format: NLM
Share it on

World J Crit Care Med. 2015 Aug 04;4(3):202-12. doi: 10.5492/wjccm.v4.i3.202. eCollection 2015 Aug 04.

Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums.

World journal of critical care medicine

Sachin Gupta, Ravindranath Tiruvoipati, Cameron Green, John Botha, Huy Tran

Affiliations

  1. Sachin Gupta, Ravindranath Tiruvoipati, Cameron Green, John Botha, Department of Intensive Care Medicine, Frankston Hospital, Frankston VIC 3199, Australia.

PMID: 26261772 PMCID: PMC4524817 DOI: 10.5492/wjccm.v4.i3.202

Abstract

Thrombocytopenia is often noted in critically ill patients. While there are many reasons for thrombocytopenia, the use of heparin and its derivatives is increasingly noted to be associated with thrombocytopenia. Heparin induced thrombocytopenia syndrome (HITS) is a distinct entity that is characterised by the occurrence of thrombocytopenia in conjunction with thrombotic manifestations after exposure to unfractionated heparin or low molecular weight heparin. HITS is an immunologic disorder mediated by antibodies to heparin-platelet factor 4 (PF4) complex. HITS is an uncommon cause of thrombocytopenia. Reported incidence of HITS in patients exposed to heparin varies from 0.2% to up to 5%. HITS is rare in ICU populations, with estimates varying from 0.39%-0.48%. It is a complex problem which may cause diagnostic dilemmas and management conundrum. The diagnosis of HITS centers around detection of antibodies against PF4-heparin complexes. Immunoassays performed by most pathology laboratories detect the presence of antibodies, but do not reveal whether the antibodies are pathological. Platelet activation assays demonstrate the presence of clinically relevant antibodies, but only a minority of laboratories conduct them. Several anticoagulants are used in management of HITS. In this review we discuss the incidence, pathogenesis, diagnosis and management of HITS.

Keywords: Critically ill; Diagnosis; Heparin; Management; Thrombocytopenia

References

  1. AMA Arch Surg. 1958 Feb;76(2):219-25; discussion 225-7 - PubMed
  2. N Engl J Med. 2006 Aug 24;355(8):809-17 - PubMed
  3. Am J Ther. 2011 Jan;18(1):14-22 - PubMed
  4. J Card Surg. 2010 May;25(3):300-2 - PubMed
  5. Blood. 2000 Oct 1;96(7):2373-8 - PubMed
  6. J Thromb Haemost. 2011 Jul;9 Suppl 1:105-17 - PubMed
  7. J Thromb Haemost. 2007 Jul;5(7):1373-9 - PubMed
  8. N Engl J Med. 2001 Apr 26;344(17):1286-92 - PubMed
  9. Anesth Analg. 2011 Oct;113(4):697-702 - PubMed
  10. Intensive Care Med. 2009 Aug;35(8):1449-53 - PubMed
  11. J Heart Lung Transplant. 2005 Feb;24(2):222-5 - PubMed
  12. N Engl J Med. 2007 Jun 21;356(25):2653-5; discussion 2653-5 - PubMed
  13. J Crit Care. 2010 Jun;25(2):287-93 - PubMed
  14. Blood. 2011 Sep 8;118(10):2882-8 - PubMed
  15. Thromb Haemost. 2005 Jan;93(1):63-9 - PubMed
  16. J Cardiothorac Vasc Anesth. 2000 Jun;14(3):243-8 - PubMed
  17. N Engl J Med. 2013 Feb 21;368(8):737-44 - PubMed
  18. Ann Intern Med. 1969 Dec;71(6):1121-5 - PubMed
  19. Blood. 1994 Dec 1;84(11):3691-9 - PubMed
  20. Chest. 2011 Aug;140(2):366-73 - PubMed
  21. Thromb Haemost. 2011 Mar;105(3):553-9 - PubMed
  22. Blood. 2010 Mar 4;115(9):1797-803 - PubMed
  23. Blood. 2013 Jul 11;122(2):272-81 - PubMed
  24. Thromb Haemost. 2010 Nov;104(5):1071-2 - PubMed
  25. Blood. 2008 Oct 1;112(7):2607-16 - PubMed
  26. Expert Opin Drug Saf. 2009 Mar;8(2):129-44 - PubMed
  27. N Engl J Med. 1995 May 18;332(20):1330-5 - PubMed
  28. Expert Rev Hematol. 2010 Oct;3(5):567-81 - PubMed
  29. J Thromb Haemost. 2010 Jan;8(1):27-9 - PubMed
  30. Surg Gynecol Obstet. 1973 Mar;136(3):409-16 - PubMed
  31. Crit Care Med. 2009 Jan;37(1):105-10 - PubMed
  32. Am J Hematol. 2010 Sep;85(9):700-6 - PubMed
  33. Clin Appl Thromb Hemost. 2010 Dec;16(6):663-7 - PubMed
  34. J Thromb Thrombolysis. 2010 Jan;29(1):1-7 - PubMed
  35. Blood. 2005 Jul 15;106(2):401-7 - PubMed
  36. Br J Haematol. 2008 Dec;143(5):721-6 - PubMed
  37. Semin Thromb Hemost. 2012 Mar;38(2):135-43 - PubMed
  38. J Thromb Haemost. 2006 Apr;4(4):759-65 - PubMed
  39. Clin Nephrol. 2006 Oct;66(4):302-5 - PubMed
  40. J Thorac Cardiovasc Surg. 2006 Mar;131(3):533-9 - PubMed
  41. Blood. 1986 Jan;67(1):27-30 - PubMed
  42. Br J Haematol. 2003 May;121(4):535-55 - PubMed
  43. Eur J Haematol. 2007 Feb;78(2):161-6 - PubMed
  44. Crit Care Med. 2010 Jun;38(6 Suppl):S145-54 - PubMed
  45. Ann Thorac Surg. 2005 Jul;80(1):299-303 - PubMed
  46. Thromb Haemost. 2012 Mar;107(3):575-83 - PubMed
  47. J Thromb Haemost. 2010 Jul;8(7):1486-91 - PubMed
  48. Crit Care. 2011;15(2):211 - PubMed
  49. Blood. 2010 Dec 2;116(23):5021-31 - PubMed
  50. Circulation. 2003 Oct 28;108(17 ):2062-5 - PubMed
  51. Blood. 2000 Sep 1;96(5):1703-8 - PubMed
  52. Thromb Haemost. 2008 Apr;99(4):779-81 - PubMed
  53. Surgery. 1964 Jun;55:803-8 - PubMed
  54. Clin Ther. 2010 Apr;32(4):626-36 - PubMed
  55. Thromb Haemost. 1997 Apr;77(4):650-5 - PubMed
  56. Chest. 2007 Jun;131(6):1735-41 - PubMed
  57. Blood. 1988 Sep;72(3):925-30 - PubMed
  58. Blood. 2011 Aug 4;118(5):1395-401 - PubMed
  59. Curr Opin Hematol. 2011 Sep;18(5):315-22 - PubMed
  60. Thromb Res. 2012 Apr;129(4):407-17 - PubMed
  61. J Thromb Haemost. 2010 Aug;8(8):1876-9 - PubMed
  62. J Thromb Haemost. 2004 Dec;2(12):2133-7 - PubMed
  63. Crit Care Med. 2007 Apr;35(4):1165-76 - PubMed
  64. Pharmacotherapy. 2006 Apr;26(4):569-577 - PubMed
  65. J Lab Clin Med. 2005 Dec;146(6):341-6 - PubMed
  66. Blood Coagul Fibrinolysis. 2011 Jan;22(1):76-8 - PubMed
  67. Thromb Res. 2011 Apr;127(4):345-8 - PubMed
  68. J Thromb Haemost. 2009 Jul;7(7):1070-4 - PubMed
  69. N Engl J Med. 1987 Mar 5;316(10):581-9 - PubMed
  70. J Thromb Haemost. 2009 Aug;7(8):1260-5 - PubMed
  71. Blood. 1991 Aug 15;78(4):1019-26 - PubMed
  72. Blood. 2000 Jul 1;96(1):182-7 - PubMed
  73. Platelets. 1999;10(5):319-26 - PubMed
  74. Blood. 2006 Nov 1;108(9):2937-41 - PubMed
  75. Br J Haematol. 1989 Oct;73(2):235-40 - PubMed
  76. J Thorac Cardiovasc Surg. 2010 Mar;139(3):790-2 - PubMed
  77. Blood. 2003 Apr 15;101(8):2955-9 - PubMed
  78. Crit Care Med. 2010 Feb;38(2 Suppl):S43-50 - PubMed

Publication Types