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Heparin induced thrombocytopenia: diagnosis and management
  1. Ali Alaraj1,
  2. Adam Wallace1,
  3. Eljim Tesoro2,
  4. Sean Ruland3,
  5. Sepideh Amin-Hanjani1,
  6. Fady T Charbel1,
  7. Victor Aletich1
  1. 1Department of Neurosurgery, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
  2. 2Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
  3. 3Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr A Alaraj, Neuropsychiatric Institute (MC-799), Department of Neurosurgery, University of Illinois at Chicago College of Medicine, 912 S Wood St Chicago, IL 60612-7329, USA; alaraj{at}


The incidence of heparin induced thrombocytopenia (HIT) in neurological patients continues to increase with expansion of indication for neurointerventional procedures. The pathophysiology of HIT is related to a hypersensitivity reaction against complex platelet factor 4. The diagnosis is mostly clinical and is often confirmed by laboratory testing. Patients with HIT have a higher rate of thromboembolic complications, both arterial and venous, and with worse neurological outcomes at the time of discharge. Early diagnosis and heparin cessation are essential in the management of those patients. Both immediate and prolonged alternative anticoagulation are necessary. Understanding of the mechanism of action, indication and drug interaction of the alternative anticoagulants (direct thrombin inhibitors, fondaparinux and danaparoid) and warfarin is essential during management of these patients.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.