Heparin-induced thrombocytopenia
ICD-10 D75.8 · ICD-11 3B64.12

Treatment of Heparin-Induced Thrombocytopenia in Subacute HIT B or Remote HIT Requiring Percutaneous Coronary Intervention

Patients with subacute HIT B or remote HIT who must undergo percutaneous coronary intervention (PCI) present a distinct anticoagulation challenge. Selecting the appropriate agent for the procedure requires careful consideration of availability and institutional experience.

Clinical Scenario Subacute HIT B or remote HIT with a requirement for percutaneous coronary intervention. The history of heparin sensitivity shapes the anticoagulation strategy for the intervention.
Treatment Approach — Partial Overview Guideline recommendations favour a specific non-heparin anticoagulant as the preferred agent for these patients during PCI, with a defined alternative when that agent is unavailable or institutional familiarity is limited, and a narrowly constrained role for heparin under particular circumstances. Full selection criteria, alternatives, and procedural conditions are in the structured protocol below.
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References

In patients with subacute HIT B or remote HIT who require PCI, the ASH guideline panel suggests treatment with bivalirudin rather than UFH (conditional recommendation, very low certainty in the evidence).

If bivalirudin is not available or if there is a lack of institutional experience, argatroban might be a suitable substitute.

Heparin is an acceptable alternative for patients with subacute HIT B or remote HIT if a suitable non-heparin anticoagulant is not available or clinician experience is lacking.

If heparin is used, exposure should be limited to the intraprocedural setting and should be avoided before and after the procedure.

DOI: 10.1182/bloodadvances.2018024489 View source ↗