Heparin-induced Thrombocytopenia (HIT) in Clinical Practice

Abstract

HIT is known as an important adverse reaction in heparin treatment, and heparin treatment should be started with keeping in mind the onset of HIT during 5-10 days after the heparin. HIT had not fully recognized in clinical practice in Japan despite management of HIT well confirmed in Western countries. Also, recognition of HIT has been evoked since argatroban had gotten the approval of FDA for prevention and treatment of HIT. Although the incidence of HIT in Japan has not yet been studied, there is a strong probability that HIT would be encountered in critical patients undergoing heparin treatment. However, there are a few case reports in annual year in Japan. Now, studies of HIT have been initiated in uremic patients requiring hemodialysis. HIT is easily recognized with clotting of extracorporeal circulation under adequate heparin anticoagulation. Hemodialysis session is often discontinued with heparin, and the re-session could be done to switch to alternative anticoagulants from heparin. In these days, argatroban is the first-choice alternative to heparin because of some experience of obtaining clinical improvements in HIT patients. Also, widespread use of laboratory tests for HIT are boosting the recognition of HIT. In Japan, management of HIT will be achieving to the goal of good practice by mean of both development of laboratory tests and application of argatroban.