Heparin-induced thrombocytopenia

The best way to prevent HIT is to minimize or avoid heparin exposure. Direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban, and edoxaban may be used as alternatives for thromboprophylaxis for some indications (e.g., following elective hip or knee arthroplasty).

The safety of prolonged re-exposure to unfractionated heparin, low molecular weight heparin (LMWH), or, more rarely, fondaparinux in patients with a previous history of HIT (i.e., currently HIT antibody negative) is unknown. Short-term exposure (<4 days) has been safely used in patients who require cardiac procedures and whose tests are currently negative for HIT antibodies. In general, avoidance of exposure to heparin is recommended in patients with a past history of HIT.

Anticoagulants such as fondaparinux, rivaroxaban, dabigatran, apixaban, edoxaban, argatroban, or bivalirudin may be reasonable alternatives to heparin in a patient with a past history of HIT depending on the clinical situation. Regional citrate anticoagulation may be an option in patients with a past history of HIT who require renal replacement.