Study aid only. Verify against current guidelines, primary literature, staging manuals, and prescribing information before clinical use.

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Heparin-Induced Thrombocytopenia (HIT): Management

First-line Second-line SECOND-LINE Suspected HIT 4T score + platelet drop Immediate After platelet recovery Stop Discontinue ALL heparin including flushes / LMWH Anticoagulate Non-heparin anticoagulant argatroban / bivalirudin / fondaparinux ↗ Avoid No platelet transfusion unless bleeding Transition DOAC or warfarin overlap; treat ≥ 3 months if thrombosis

Heparin-Induced Thrombocytopenia (HIT): overview

This algorithm outlines management of suspected heparin-induced thrombocytopenia, triggered by a 4T score assessment together with a platelet drop.

Immediate management has three components. All heparin is discontinued, including heparin flushes and low-molecular-weight heparin. A non-heparin anticoagulant is started: argatroban, bivalirudin or fondaparinux. Platelet transfusion is avoided unless the patient is bleeding. After platelet recovery, patients transition to a DOAC or warfarin, with overlap during the transition, and treatment continues for at least 3 months if thrombosis occurred. The central principle is that suspected HIT requires both removal of heparin and active anticoagulation with an alternative agent, rather than simply stopping heparin, before any oral agent is introduced once platelets recover.

Trials behind this algorithm

Heparin-Induced Thrombocytopenia (HIT): the algorithm in words

Starting point: Suspected HIT 4T score + platelet drop.