Diagnosis and management of heparin-induced thrombocytopenia: Third edition

Diagnosis and management of heparin-induced thrombocytopenia: Third edition - British Society for Haematology (BSH)

This guideline updates and widens the scope of the previous British Society for Haematology (BSH) Clinical guidelines for Diagnosis and Management of Heparin-Induced Thrombocytopenia: Second Edition1 to include functional assays in the diagnosis of heparin-induced thrombocytopenia (HIT), when to use direct-acting oral anti-coagulants, and the role of intravenous (IV) immunoglobulins and plasma exchange in the management of HIT and spontaneous HIT.

HIT is an immune-mediated, highly pro-thrombotic disorder of platelet activation caused by pathogenic antibodies against a platelet factor 4 (PF4)–heparin complex. It is the most frequent drug-induced immune thrombocytopenia and may lead to life-threatening thrombosis. There are two distinct forms of HIT: type I, also known as heparin-associated thrombocytopenia, which is a non-immunological response to heparin treatment, mediated by a direct interaction between heparin and circulating platelets causing platelet clumping or sequestration, and type II, which is immune mediated.


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