Heparin-induced thrombocytopenia (HIT)

Stop ALL heparin immediately
Start non-heparin anticoagulant if likely HIT

argatroban/bivalirudin or selected Xa drug

Do not await confirmatory test if high probability
Avoid platelet transfusion unless bleeding
Delay warfarin until platelets recover
Document heparin allergy clearly

Use at a glance

Stop ALL heparin immediately

Safety / pitfalls

Delay warfarin until platelets recover
Document heparin allergy clearly

Choosing treatment

Start non-heparin anticoagulant if likely HIT

argatroban/bivalirudin or selected Xa drug

Treatment pitfalls

Do not await confirmatory test if high probability
Avoid platelet transfusion unless bleeding

Self-check

What should be stopped immediately in HIT?
ALL heparin.
When should warfarin start after HIT?
After platelet recovery.

Drugs used for this (3)

Argatroban ballicule — decagon mechanism diagram — Argatroban

Bivalirudin ballicule — decagon mechanism diagram — Bivalirudin — off-label

Fondaparinux ballicule — decagon mechanism diagram — Fondaparinux — off-label

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