Episode 017: Heme/Onc Emergencies, Pt. 6: Heparin-Induced Thrombocytopenia (HIT)

Heparin-induced thrombocytopenia (HIT) is explored, focusing on its diagnosis and management. The discussion begins with a case of a post-operative CABG patient who developed a DVT and thrombocytopenia despite anticoagulation. HIT is defined as an antibody-mediated process where heparin binds to platelet factor 4, activating platelets and causing thrombosis. The 4T scoring system is detailed as a method to assess the pretest probability of HIT, considering thrombocytopenia, timing, thrombosis, and other potential causes. Diagnosis involves ELISA and serotonin release assays to confirm antibody presence and activity. Treatment includes stopping heparin and switching to alternative anticoagulants like Argatroban or Fondaparinox until platelet recovery, with extended anticoagulation for those with thrombosis.