Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presença de fatores de risco
- história de exposição recente à heparina
- história de TIH
- ausência de condições e medicamentos que causam trombocitopenia
- história de cirurgia ou trauma recente
- características consistentes com evento tromboembólico venoso ou arterial recente (por exemplo, embolia pulmonar [EP], trombose venosa profunda [TVP], acidente vascular cerebral [AVC], infarto do miocárdio [IAM])
- necrose nos locais de injeção da heparina
Otros factores de diagnóstico
- ausência de sangramento
- sinais de necrose hemorrágica adrenal
- reação sistêmica aguda
- sinais de gangrena venosa de membros
Factores de riesgo
- exposição recente à heparina (nos últimos 100 dias)
- cirurgia ortopédica ou cardiovascular recente
- sexo feminino
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- Hemograma completo
Pruebas diagnósticas que deben considerarse
- Escore 4Ts
- ensaio de antígeno de TIH
- Ensaio funcional de TIH
- exames de coagulação
- ultrassonografia Doppler venosa
- angiografia pulmonar por tomografia computadorizada (APTC)
- cintilografia de ventilação/perfusão (cintilografia V/Q)
- angiotomografia venosa cerebral
- venografia por ressonância magnética (crânio)
Algoritmo de tratamiento
suspeita de TIH com escore de 4Ts ≥4 ou TIH aguda confirmada
trombocitopenia induzida por heparina (TIH) suspeita com escore de 4Ts ≤3
recuperação de plaquetas (TIH A subaguda)
TIH remota
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
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.
Diferenciales
- Estado pós-operatório
- Púrpura trombocitopênica trombótica
- Púrpura trombocitopênica induzida por medicamentos
Más DiferencialesGuías de práctica clínica
- Guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia
- Treatment and prevention of heparin-induced thrombocytopenia (9th ed)
Más Guías de práctica clínica
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