Heparin induced thrombocytopenia: diagnosis, treatment, challenges and future of testing

Dea Donikian, Emmanuel Favaloro, Abishek Santhakumar, Robyn Jarman, Timothy Brighton

Research output: Contribution to journalReview articlepeer-review


Diagnosis of heparin induced thrombocytopenia (HIT) involves a comprehensive approach combining clinical assessment
and laboratory investigations. The 4T score system is commonly utilized to assess the probability of HIT although its
subjective nature and lack of sensitivity and specificity present limitations. Laboratory tests such as platelet activation
assays and immunoassays are being explored to complement clinical judgment and enhance diagnostic accuracy. These
tests have the potential to provide objective information to support or refute the diagnosis of HIT thereby improving
patient outcomes by reducing the risk of both overdiagnosis and underdiagnosis.
Treatment of HIT primarily involves the prompt discontinuation of heparin therapy and initiation of alternative
anticoagulation strategies. Direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) such as danaproid
and fondaparinux as well as parenteral direct thrombin inhibitors (DTIs) are commonly used alternatives; however careful
consideration must be given to individual patient factors. Close monitoring for thrombotic complications and adequate
management of ongoing anticoagulation are crucial elements of HIT treatment.
Challenges in HIT management include the need for rapid and reliable diagnostic tools, as well as the potential for
misdiagnosis due to the overlapping clinical features of HIT with other conditions. The availability and cost of alternative
anticoagulants can also pose challenges in resource-limited settings. Clear communication and interdisciplinary
collaboration among healthcare providers are essential to ensure optimal management and patient safety.
The future of HIT testing holds promise with ongoing research and development. Advancements in laboratory assays
aim to improve diagnostic precision and aid in the differentiation of HIT from other causes of thrombocytopenia. These
evolving tests have the potential to enhance sensitivity and specificity, thereby reducing the risk of unnecessary treatment
modifications and associated complications., The identification of novel biomarkers and genetic markers may further
contribute to earlier detection and personalized management of HIT
Original languageEnglish
JournalAustralian Journal of Medical Science
Issue number4
Publication statusPublished - Feb 2024


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