The clinical management of heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is an immunologic complication of drug therapy with potentially serious venous and arterial thrombotic sequelae. Recent studies have provided insight into the molecular and cellular basis of HIT underlying the diagnosis and treatment of this syndrome. Because various approaches to HIT treatment have resulted in mixed success, the use of heparin substitutes, other anticoagulant agents, and adjunctive therapy needs to be clarified. For patients with pre-existing conditions such as deep venous thrombosis or pulmonary embolism, new understanding of the clinicopathologic syndrome of HIT offers the promise of improved antithrombotic therapy. The participation of thrombin in HIT suggests that specific (hirudin and argatroban) thrombin inhibitors may be ideal agents for treating acute HIT.