Heparin-Induced Thrombocytopenia: Is There a Role for Direct Thrombin Inhibitors in Therapy?

Abstract

Heparin is widely used in the intensive care environment usually for thromboprophylaxis but also to facilitate extra-corporeal circuits such as renal replacement and ECMO. Heparin-induced thrombocytopenia (HIT) is a rare but extremely serious disorder. It is associated with significant morbidity and mortality. The diagnosis is often challenging particularly as thrombocytopenia can be caused by a number of other common conditions seen in intensive care. Unfortunately routine screening for HIT antibodies is not helpful as it is possible to have these but have no manifestation of the disease process. If the diagnosis of HIT is not considered and the patient does in fact have the disease process they are at risk of thrombotic episodes. This article reviews the pathophysiology of HIT and the challenges with making the diagnosis. We explore the role of newer anticoagulants that may have a role such as direct thrombin inhibitors.