Hit Realities

Medical professionals have to be highly knowledgeable about HIT, a relatively common and serious clinical problem. It can be prevented by avoiding unnecessary heparin exposures (e.g., heparin flushes), by increasing, where appropriate, the use of LMWH or fondaparinux rather than UFH, and through appropriate platelet count monitoring. In addition to the lack of attention traditionally devoted to HIT in medical curricula and textbooks, obstacles to addressing the problem include greater awareness of the paradoxes and myths surrounding it. HIT produces the most extreme prothrombotic diathesis, so upon reasonable clinical suspicion, an alternative anticoagulant must be initiated. Key to preventing catastrophes is knowledge, vigilance, and maintenance of a high degree of suspicion: HIT must be a prime consideration whenever a patient in the hospital (or recently hospitalized) suffers a fall in platelet count or a new venous or arterial thrombotic event. The temporal relationship of such events to heparin exposure has to be analyzed. Physician thinking must get past the notion that this drug reaction can be reversed simply by stopping the drug. By appreciating the paradoxes and exposing the myths, we can move forward, particularly now that effective agents and strategies are available for prevention and treatment.

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