This protocol addresses patients with a prior history of heparin-induced thrombocytopenia (remote HIT) who subsequently require anticoagulation for venous thromboembolism (VTE) treatment or prophylaxis.
A past episode of HIT changes how anticoagulation must be approached when VTE management is later needed. Using heparin-based agents in this context carries specific risks that guide agent selection.
Evidence-based guidance strongly recommends using a non-heparin anticoagulant in this setting rather than standard heparin-based options.
DOI: 10.1182/bloodadvances.2018024489
In patients with remote HIT who require VTE treatment or prophylaxis, the ASH guideline panel recommends administration of a non-heparin anticoagulant (eg, apixaban, dabigatran, danaparoid, edoxaban, fondaparinux, rivaroxaban, or a VKA) rather than UFH or LMWH (strong recommendation, very low certainty in the evidence about effects).
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