Department of Pediatrics, Division of Hematology Oncology, Oregon Health & Science University, Portland, OR, USA.
Department of Medicine, Division of Cardiology and Hematology, New York University School of Medicine, New York, NY, USA.
Vasc Med. 2020 Apr;25(2):160-173. doi: 10.1177/1358863X19898253. Epub 2020 Mar 20.
Heparin-induced thrombocytopenia (HIT) is a life and limb-threatening complication of heparin exposure. Here, we review the pathogenesis, incidence, diagnosis, and management of HIT. The first step in thwarting devastating complications from this entity is to maintain a high index of clinical suspicion, followed by an accurate clinical scoring assessment using the 4Ts. Next, appropriate stepwise laboratory testing must be undertaken in order to rule out HIT or establish the diagnosis. In the interim, all heparin must be stopped immediately, and the patient administered alternative anticoagulation. Here we review alternative anticoagulation choice, therapy alternatives in the difficult-to-manage patient with HIT, and the problem of overdiagnosis.
肝素诱导的血小板减少症（HIT）是肝素暴露引起的危及生命和肢体的并发症。在这里，我们回顾了 HIT 的发病机制、发病率、诊断和管理。阻止这种疾病发生严重并发症的第一步是保持高度的临床怀疑，然后使用 4Ts 进行准确的临床评分评估。接下来，必须进行适当的逐步实验室检查，以排除 HIT 或确立诊断。在此期间，必须立即停止所有肝素，并给患者使用替代抗凝剂。在这里，我们回顾了替代抗凝选择、HIT 患者的治疗选择以及过度诊断的问题。
