Heparin-induced thrombocytopenia and recent advances in its therapy

OBJECTIVES: To highlight therapeutic controversies, and present a critical review of the most recent evidence on the management of heparin-induced thrombocytopenia (HIT). DATA SOURCES: A MEDLINE search from October 1996 until October 2006 was carried out. Pertinent literature was identified and other references identified from the bibliographic citations of the articles identified on MEDLINE. STUDY SELECTION: Articles related to the treatment of HIT including meta-analyses, systematic reviews, critical reviews, randomized and non-randomized trials, as well as case-reports, were reviewed. RESULTS AND CONCLUSION: The diagnostic and therapeutic dilemmas associated with HIT can be overwhelming and call for an evidence-based approach in the management of this frequently fatal event. HIT is associated with significant morbidity and mortality. The evidence suggests when heparin is stopped, alternative anticoagulant therapy with one of the newer agents such as lepirudin and argatroban is of benefit in avoiding deaths and morbidity.