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Heparin-induced thrombocytopenia

Última revisão: 20 Aug 2025
Última atualização: 20 Jun 2023

Resumo

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • history of recent heparin exposure
  • history of HIT
  • absence of conditions and medications that cause thrombocytopenia
  • history of recent surgery or trauma
  • features consistent with recent venous or arterial thromboembolic event (e.g., PE, DVT, stroke, MI)
  • necrosis at heparin injection site(s)
Todos los datos

Otros factores de diagnóstico

  • absence of bleeding
  • signs of adrenal hemorrhagic necrosis
  • acute systemic reaction
  • signs of venous limb gangrene
Todos los datos

Factores de riesgo

  • recent heparin exposure (within past 100 days)
  • recent orthopedic or cardiovascular surgery
  • female sex
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • CBC
Todos los datos

Pruebas diagnósticas que deben considerarse

  • 4Ts score
  • HIT antigen assay
  • HIT functional assay
  • coagulation studies
  • venous Doppler ultrasound
  • computed tomography pulmonary angiogram (CTPA)
  • ventilation-perfusion scan (V/Q scan)
  • cerebral computed tomography venogram
  • magnetic resonance venography (head)
Todos los datos

Algoritmo de tratamiento

Agudo

suspected HIT with 4Ts score ≥4, or confirmed acute HIT

suspected HIT with 4Ts score ≤3

En curso

platelet recovery (subacute HIT A)

remote HIT

Colaboradores

Autores

Lori-Ann Linkins, MD, MSc(Clin Epi), FRCPC

Associate Professor

Department of Medicine

McMaster University

Thrombosis Consultant

Juravinski Hospital and Cancer Centre

Hamilton

Ontario

Canada

Divulgaciones

LL is an author of several references cited in this topic.

Revisores por pares

Jeffrey S. Wasser, MD

Assistant Clinical Professor of Medicine

Acting Associate Chair of the Division of Hematology and Medical Oncology

University of Connecticut School of Medicine

Farmington

CT

Divulgaciones

JSW declares that he has no competing interests.

Henry Watson, MD, FRCP, FRCPath

Consultant Haematologist

Aberdeen Royal Infirmary

Foresterhill Health Campus

Aberdeen

UK

Divulgaciones

HW declares that he has no competing interests.

Simon Davidson, MPhil

Clinical Scientist

Royal Brompton Hospital

Honorary Clinical Lecturer

Imperial College London

London

UK

Divulgaciones

SD is a consultant for Mitsubishi Pharma, the manufacturer of argatroban.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Warkentin T, Kelton J. Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med. 2001;344:1286-1292.Texto completo  Resumen

Cuker A, Arepally GM, Chong BH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018 Nov 27;2(22):3360-92.Texto completo  Resumen

Linkins LA, Dans AL, Moores LK, et al. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis (9th ed). American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e495S-e530S.Texto completo  Resumen

Watson H, Davidson S, Keeling D, et al. Guidelines on the diagnosis and management of heparin-induced thrombocytopenia: second edition. Br J Haematol. 2012 Dec;159(5):528-40.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Heparin-induced thrombocytopenia images
  • Diferenciales

    • Postoperative state
    • Thrombotic thrombocytopenic purpura
    • Drug-induced thrombocytopenic purpura
    Más Diferenciales
  • Guías de práctica clínica

    • Guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia
    • Treatment and prevention of heparin-induced thrombocytopenia
    Más Guías de práctica clínica
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