Heparin-induced thrombocytopenia and thrombosis.

Heparin-induced thrombocytopenia and thrombosis can occur with both low-dose and high-dose heparin. Clinicians should be aware of this syndrome, and platelet counts should be monitored prior to initiating heparin and during the course of therapy. The treatment of heparin-induced thrombocytopenia is variable depending on the use of heparin in each individual patient. Treatment options include discontinuation of heparin, initiation of warfarin in place of heparin, and possibly switching from bovine to porcine heparin in milder cases. Intravenous immunoglobin is the most recent treatment option reported for heparin-induced thrombocytopenia and thrombosis. The patient with heparin-induced thrombocytopenia and thrombosis requiring emergency cardiac surgery and reexposure to heparin is more difficult to manage. Aspirin given with dipyridamole or Iloprost have both been reported to be successful in managing this group of patients. Heparin is a commonly used drug in all areas of medicine. The early recognition and treatment of heparin-induced thrombocytopenia and thrombosis has resulted in a reduction in the morbidity associated with this syndrome.