NEW YORK (Reuters Health) – Reports of heparin-induced thrombocytopenia (HIT) occurring 5 to 12 days after heparin exposure are increasingly common, according to a report in the February 5th issue of the Annals of Internal Medicine. And researchers caution that delayed recognition and treatment of this complication can have disastrous consequences.
"HIT is a very common problem which is tragically under-diagnosed–and it is more tragic now that we have more effective therapies," Dr. Lawrence Rice from Baylor College of Medicine in Houston, Texas told Reuters Health.
Dr. Rice and colleagues described the clinical scenarios of 14 patients, who met their criteria for delayed onset HIT, to raise awareness of this increasingly common medical problem.
HIT had been suspected in only one of the patients during the initial hospital admission, the authors report. Eight other patients did not have a platelet count checked for several days prior to initial discharge, 3 had normal platelet counts before discharge and 3 patients had low platelet counts. All 14 patients tested positive for heparin-induced antibodies.
Thrombotic complications, seen a median of 13 days after initial heparin exposure, included venous thromboembolism in 12 patients (7 of them with pulmonary embolism) and arterial thrombosis in 4 patients (2 patients had both), the results indicate.
Eleven of the patients had mild to moderate thrombocytopenia on admission for their thrombotic complications, the researchers note, and only 2 had normal platelet counts.
Eleven patients were retreated with heparin, the investigators say, precipitating a fall in platelet counts within 24 hours in all of these patients.
Once HIT was recognized, the patients were treated with alternative anticoagulants (11 patients), tissue plasminogen activator (3 patients), inferior vena cava filters (3 patients), and surgical embolectomy (1 patient). Eleven patients eventually received warfarin.
According to the report, three patients died, and the median hospital stay was 9 days.
"One must maintain alertness about HIT if one is to avoid catastrophic complications and deaths in these patients," Dr. Rice said. "Because heparin use in hospitals is ubiquitous…and the heparin exposures may be occult," he believes that "any recently hospitalized patient returning with a low platelet count and/or a new blood clot must be considered to be a possible HIT patient."
"Patients with a clot and a suspicion of HIT need to be treated with one of the alternative anticoagulants–argatroban, lepirudin, or danaparoid," Dr. Rice added. "In unusual, severe cases, thrombolytic therapy may be employed first."
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