PMID- 18574270
OWN - NLM
STAT- MEDLINE
DCOM- 20080826
LR  - 20220321
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 133
IP  - 6 Suppl
DP  - 2008 Jun
TI  - Treatment and prevention of heparin-induced thrombocytopenia: American College of 
      Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).
PG  - 340S-380S
LID - S0012-3692(08)60122-1 [pii]
LID - 10.1378/chest.08-0677 [doi]
AB  - This chapter about the recognition, treatment, and prevention of heparin-induced 
      thrombocytopenia (HIT) is part of the Antithrombotic and Thrombolytic Therapy: 
      American College of Chest Physicians Evidence-Based Clinical Practice Guidelines 
      (8th Edition). Grade 1 recommendations are strong and indicate that the benefits 
      do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that 
      individual patient values may lead to different choices. Among the key 
      recommendations in this chapter are the following: For patients receiving heparin 
      in whom the clinician considers the risk of HIT to be > 1.0%, we recommend 
      platelet count monitoring over no platelet count monitoring (Grade 1C). For 
      patients who are receiving heparin or have received heparin within the previous 2 
      weeks, we recommend investigating for a diagnosis of HIT if the platelet count 
      falls by >/= 50%, and/or a thrombotic event occurs, between days 5 and 14 
      (inclusive) following initiation of heparin, even if the patient is no longer 
      receiving heparin therapy when thrombosis or thrombocytopenia has occurred (Grade 
      1C). For patients with strongly suspected (or confirmed) HIT, whether or not 
      complicated by thrombosis, we recommend use of an alternative, nonheparin 
      anticoagulant (danaparoid [Grade 1B], lepirudin [Grade 1C], argatroban [Grade 
      1C], fondaparinux [Grade 2C], or bivalirudin [Grade 2C]) over the further use of 
      unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) therapy or 
      initiation/continuation of vitamin K antagonists (VKAs) [Grade 1B]. The 
      guidelines include specific recommendations for nonheparin anticoagulant dosing 
      that differ from the package inserts. For patients with strongly suspected or 
      confirmed HIT, we recommend against the use of vitamin K antagonist (VKA) 
      [coumarin] therapy until after the platelet count has substantially recovered 
      (usually, to at least 150 x 10(9)/L) over starting VKA therapy at a lower 
      platelet count (Grade 1B); that VKA therapy be started only with low maintenance 
      doses (maximum, 5 mg of warfarin or 6 mg of phenprocoumon) over higher initial 
      doses (Grade 1B); and that the nonheparin anticoagulant (eg, lepirudin, 
      argatroban, danaparoid) be continued until the platelet count has reached a 
      stable plateau, the international normalized ratio (INR) has reached the intended 
      target range, and after a minimum overlap of at least 5 days between nonheparin 
      anticoagulation and VKA therapy rather than a shorter overlap (Grade 1B). For 
      patients receiving VKAs at the time of diagnosis of HIT, we recommend use of 
      vitamin K (10 mg po or 5 to 10 mg IV) [Grade 1C].
FAU - Warkentin, Theodore E
AU  - Warkentin TE
AD  - From McMaster University, Hamilton, ON, Canada. Electronic address: 
      twarken@mcmaster.ca.
FAU - Greinacher, Andreas
AU  - Greinacher A
AD  - Institute for Immunology and Transfusion Medicine, Ernst-Moritz-Arndt University 
      Greifswald, Greifswald, Germany.
FAU - Koster, Andreas
AU  - Koster A
AD  - Deutsches Herzzentrum Berlin, Berlin, Germany.
FAU - Lincoff, A Michael
AU  - Lincoff AM
AD  - Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 
      The Cleveland Clinic Foundation, Cleveland, OH.
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Coumarins)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
RN  - A4VZ22K1WT (coumarin)
SB  - IM
EIN - Chest. 2011 May;139(5):1261. Dosage error in article text
MH  - Coumarins/*therapeutic use
MH  - *Evidence-Based Medicine
MH  - Fibrinolytic Agents/*adverse effects
MH  - Heparin/*adverse effects
MH  - Humans
MH  - Platelet Count
MH  - *Thrombocytopenia/chemically induced/drug therapy/prevention & control
EDAT- 2008/07/24 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/07/24 09:00
PHST- 2008/07/24 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/07/24 09:00 [entrez]
AID - S0012-3692(08)60122-1 [pii]
AID - 10.1378/chest.08-0677 [doi]
PST - ppublish
SO  - Chest. 2008 Jun;133(6 Suppl):340S-380S. doi: 10.1378/chest.08-0677.