Dr. Juan Carlos Souto
Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, et al.
Chest. 2012;141(2 Suppl):e495S-530S
Background:
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated adverse drug reaction that can lead to devastating thromboembolic complications, including pulmonary embolism, ischemic limb necrosis necessitating limb amputation, acute myocardial infarction, and stroke.
Methods:
The methods of this guideline follow the Methodology for the Development Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.
Results:
Among the key recommendations for this article are the following: For patients receiving heparin in whom clinicians consider the risk of HIT to be > 1%, we suggest that platelet count monitoring be performed every 2 or 3 days from day 4 to day 14 (or until heparin is stopped, whichever occurs first) (Grade 2C). For patients receiving heparin in whom clinicians consider the risk of HIT to be < 1%, we suggest that platelet counts not be monitored (Grade 2C). In patients with HIT with thrombosis (HITT) or isolated HIT who have normal renal function, we suggest the use of argatroban or lepirudin or danaparoid over other nonheparin anticoagulants (Grade 2C). In patients with HITT and renal insufficiency, we suggest the use of argatroban over other nonheparin anticoagulants (Grade 2C). In patients with acute HIT or subacute HIT who require urgent cardiac surgery, we suggest the use of bivalirudin over other nonheparin anticoagulants or heparin plus antiplatelet agents (Grade 2C).
Conclusions:
Further studies evaluating the role of fondaparinux and the new oral anticoagulants in the treatment of HIT are needed.
Comentario del Dr. Juan Carlos Souto
Esta guía reúne varias recomendaciones relacionadas con la trombocitopenia inducida por heparina (TIH). Se aconseja que en pacientes que reciban tratamiento con heparina no fraccionada se realice un recuento de la cifra de plaquetas cada 2-3 días durante las dos primeras semanas de tratamiento para realizar un diagnóstico precoz de TIH. En los pacientes con diagnóstico de TIH con función renal normal se recomienda el uso de argatrobán, lepirudina o danaparoide por encima de otros anticoagulantes (el danaparoide no está comercializado en nuestro medio). En pacientes con insuficiencia renal, se recomienda preferentemente argatrobán.