n CME : Your SA Journal of CPD - Heparin and heparin-induced thrombocytopenia : main article




  • HIT is a common and serious immune mediated drug reaction.
  • Any form of heparin may cause the reaction.
  • The incidence is higher with UFH (~3%) than LMWH.
  • Surgical patients are at highest risk, especially those who have had orthopaedic surgery.
  • The platelet count typically falls by > 50% 5 - 10 days after first exposure to heparin. This occurs sooner in patients with previous heparin exposure.
  • The heparin-induced antibody complex causes platelet activation, leading to thrombosis, usually venous.
  • Half of those with HIT will develop associated thrombosis which has a high mortality rate.
  • A clinical scoring system ('the 4 Ts') is useful to make the diagnosis.
  • Appropriate management involves promptly ceasing heparin and instituting full-dose alternative anticoagulation.
  • Warfarin should NOT be given in the acute setting as it may precipitate thrombosis, and platelet transfusions should be avoided.


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