We Can Wait for the Test to Come Back

The time just after heparin is stopped may be the most dangerous for the emergence of thromboemboli, because heparin may be exerting some protective anticoagulant effect at the same time it is feeding a prothrombotic maelstrom. The protocol for the lepirudin registration trials in Europe called for heparin to be stopped when HIT is suspected, but lepirudin was initiated only after obtaining positive serologic results; a 6% per day thrombosis event rate was observed while physicians awaited the test results (Greinacher et al., 2000). The initial suspicion for HIT depends on clinical features, such as the 4 T's (Thrombocytopenia, Timing, Thrombosis, oTher causes of thrombocytopenia unlikely) (Lo et al., 2006); when HIT is reasonably suspected, an alternative anticoagulant should be initiated, and the results of serologic tests considered later.

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