Tags

Type your tag names separated by a space and hit enter

Diagnosis and management of heparin-induced thrombocytopenia: a consensus statement from the Thrombosis and Haemostasis Society of Australia and New Zealand HIT Writing Group.
Med J Aust 2019; 210(11):509-516MJ

Abstract

INTRODUCTION

Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder that occurs following the administration of heparin and is caused by antibodies to platelet factor 4 and heparin. Diagnosis of HIT is essential to guide treatment strategies using non-heparin anticoagulants and to avoid unwanted and potential fatal thromboembolic complications. This consensus statement, formulated by members of the Thrombosis and Haemostasis Society of Australia and New Zealand, provides an update on HIT pathogenesis and guidance on the diagnosis and management of patients with suspected or confirmed HIT.

MAIN RECOMMENDATIONS

A 4Ts score is recommended for all patients with suspected HIT prior to laboratory testing. Further laboratory testing with a screening immunoassay or confirmatory functional assay is not recommended in individuals with a low 4Ts score. However, if there are missing or unreliable clinical data, then laboratory testing should be performed. A positive functional assay result confirms the diagnosis of HIT and should be performed to confirm a positive immunoassay result. Heparin exposure must be ceased in patients with suspected or confirmed HIT and initial treatment with a non-heparin alternative instituted. Non-heparin anticoagulants (danaparoid, argatroban, fondaparinux and bivalirudin) used to treat HIT should be given in therapeutic rather than prophylactic doses. Direct oral anticoagulants may be used in place of warfarin after patients with HIT have responded to alternative parenteral anticoagulants with platelet count recovery.

CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT

These are the first Australasian recommendations for diagnosis and management of HIT, with a focus on locally available diagnostic assays and therapeutic options. The importance of examining both clinical and laboratory data in considering a diagnosis of HIT cannot be overstated.

Authors+Show Affiliations

St Vincent's Hospital, Sydney, NSW. St Vincent's Clinical School, University of New South Wales, Sydney, NSW.Royal North Shore Hospital, Sydney, NSW. Northern Blood Research Centre, Kolling Institute of Medical Research, Sydney, NSW.Calvary Mater Hospital, Sydney, NSW.Institute of Clinical Pathology and Medical Research, Sydney, NSW. Westmead Hospital, Sydney, NSW.Northern Blood Research Centre, Kolling Institute of Medical Research, Sydney, NSW.Royal Adelaide Hospital, Adelaide, SA.Institute of Clinical Pathology and Medical Research, Sydney, NSW. Westmead Hospital, Sydney, NSW.Royal Adelaide Hospital, Adelaide, SA.Royal North Shore Hospital, Sydney, NSW. Northern Blood Research Centre, Kolling Institute of Medical Research, Sydney, NSW.St George Hospital, Sydney, NSW.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31155728

Citation

Joseph, Joanne, et al. "Diagnosis and Management of Heparin-induced Thrombocytopenia: a Consensus Statement From the Thrombosis and Haemostasis Society of Australia and New Zealand HIT Writing Group." The Medical Journal of Australia, vol. 210, no. 11, 2019, pp. 509-516.
Joseph J, Rabbolini D, Enjeti AK, et al. Diagnosis and management of heparin-induced thrombocytopenia: a consensus statement from the Thrombosis and Haemostasis Society of Australia and New Zealand HIT Writing Group. Med J Aust. 2019;210(11):509-516.
Joseph, J., Rabbolini, D., Enjeti, A. K., Favaloro, E., Kopp, M. C., McRae, S., ... Chong, B. H. (2019). Diagnosis and management of heparin-induced thrombocytopenia: a consensus statement from the Thrombosis and Haemostasis Society of Australia and New Zealand HIT Writing Group. The Medical Journal of Australia, 210(11), pp. 509-516. doi:10.5694/mja2.50213.
Joseph J, et al. Diagnosis and Management of Heparin-induced Thrombocytopenia: a Consensus Statement From the Thrombosis and Haemostasis Society of Australia and New Zealand HIT Writing Group. Med J Aust. 2019;210(11):509-516. PubMed PMID: 31155728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and management of heparin-induced thrombocytopenia: a consensus statement from the Thrombosis and Haemostasis Society of Australia and New Zealand HIT Writing Group. AU - Joseph,Joanne, AU - Rabbolini,David, AU - Enjeti,Anoop K, AU - Favaloro,Emmanuel, AU - Kopp,Marie-Christine, AU - McRae,Simon, AU - Pasalic,Leonardo, AU - Tan,Chee Wee, AU - Ward,Christopher M, AU - Chong,Beng H, Y1 - 2019/06/02/ PY - 2019/6/4/pubmed PY - 2019/6/4/medline PY - 2019/6/4/entrez KW - Anticoagulants KW - Blood platelet disorders KW - Guidelines as topic SP - 509 EP - 516 JF - The Medical journal of Australia JO - Med. J. Aust. VL - 210 IS - 11 N2 - INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder that occurs following the administration of heparin and is caused by antibodies to platelet factor 4 and heparin. Diagnosis of HIT is essential to guide treatment strategies using non-heparin anticoagulants and to avoid unwanted and potential fatal thromboembolic complications. This consensus statement, formulated by members of the Thrombosis and Haemostasis Society of Australia and New Zealand, provides an update on HIT pathogenesis and guidance on the diagnosis and management of patients with suspected or confirmed HIT. MAIN RECOMMENDATIONS: A 4Ts score is recommended for all patients with suspected HIT prior to laboratory testing. Further laboratory testing with a screening immunoassay or confirmatory functional assay is not recommended in individuals with a low 4Ts score. However, if there are missing or unreliable clinical data, then laboratory testing should be performed. A positive functional assay result confirms the diagnosis of HIT and should be performed to confirm a positive immunoassay result. Heparin exposure must be ceased in patients with suspected or confirmed HIT and initial treatment with a non-heparin alternative instituted. Non-heparin anticoagulants (danaparoid, argatroban, fondaparinux and bivalirudin) used to treat HIT should be given in therapeutic rather than prophylactic doses. Direct oral anticoagulants may be used in place of warfarin after patients with HIT have responded to alternative parenteral anticoagulants with platelet count recovery. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: These are the first Australasian recommendations for diagnosis and management of HIT, with a focus on locally available diagnostic assays and therapeutic options. The importance of examining both clinical and laboratory data in considering a diagnosis of HIT cannot be overstated. SN - 1326-5377 UR - https://www.unboundmedicine.com/medline/citation/31155728/Diagnosis_and_management_of_heparin-induced_thrombocytopenia:_a_consensus_statement_from_the_Thrombosis_and_Haemostasis_Society_of_Australia_and_New_Zealand_HIT_Writing_Group L2 - https://doi.org/10.5694/mja2.50213 DB - PRIME DP - Unbound Medicine ER -