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Heparin-Induced Thrombocytopenia by Deanna M. Neff

Definition

Platelets are a special type of blood cell. They help form clots so that you do not bleed too much. Heparin is a blood-thinning medication that decreases clotting.

Thrombocytopenia means low blood platelet count. Heparin-induced thrombocytopenia is low blood platelet count caused by heparin. This condition can lead to a lot of bleeding. In some cases, it can also develop into excessive blood clotting. About 1%-2% of patients taking heparin may develop this condition.

This can become a serious condition. It requires care from your doctor.

Clot Formation

Causes

This type of thrombocytopenia is caused by taking heparin.

Risk Factors

Taking heparin is a risk factor for developing this condition. You may be taking heparin if you have had:

Certain heart, lung, or blood vessel conditions
Surgery such as heart or orthopedic surgery
Kidney dialysis and blood transfusions

You may also be taking it if you are bedridden. Tell your doctor if you are taking heparin.

Symptoms

If you have any of these symptoms, do not assume it is due to this condition. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

Bleeding
- Excessive bleeding from cuts
- Bleeding from your gums or nose
- Superficial bleeding on the skin (looks like reddish/purple spots, often on the legs)
- Blood in urine or stool
- Heavy menstrual flow
- Excessive bleeding during surgery
Pain or swelling in the legs
Chest pain
Difficulty breathing
Anxiety
Sweating
Rapid, irregular heartbeat

Also let your doctor know if you have past blood tests showing a low blood platelet count.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include the following:

Complete blood count (CBC) —a routine blood test that shows your platelet count
Other special blood tests, such as a heparin-induced platelet aggregation test
Ultrasound of limbs or other areas to detect a clot

Treatment

Talk with your doctor about the best plan for you. Treatment options include the following:

Stopping the use of heparin
Anticoagulating drugs—to reduce the risk of blood clots:
- Danaparoid
- Refludan ( lepirudin )
- Argatroban
- Arixtra ( fondaparinux)
- Angiomax (bivalirudin)
Vitamin K Antagonists Therapy (VKA)— Vitamin K given once your platelet count has recovered
Blood transfusion —for severe bleeding, to replace lost blood

Prevention

To help reduce your chance of getting heparin-induced thrombocytopenia, discuss with your doctor the following:

Avoiding heparin use
Taking anticoagulants, such as Argatroban or Angiomax (bivalirudin)

RESOURCES:

American Academy of Family Physicians http://www.aafp.org/
American Heart Association http://www.americanheart.org/

CANADIAN RESOURCES:

Canadian Cardiovascular Society http://www.ccs.ca/home/index_e.aspx
Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/
Thrombosis Interest Group of Canada http://www.tigc.org/

References:

Arepally G, Ortel T. Heparin-induced thrombocytopenia. N Engl J Med . 2006. 355;8: 809-17. Available at: http://enotes.tripod.com/thrombocytopenia_heparin2006.pdf . Accessed May 26, 2009.
Heparin-induced thrombocytopenia. EBSCO Dynamed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 3, 2008. Accessed May 26, 2009.
Mayo Clinic. Heparin. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/drug-information/DR601931 . Accessed May 26, 2009.
Thrombocytopenia (low platelet count). Mayo Clinic website. Available at: http://www.mayoclinic.com/health/thrombocytopenia/DS00691/DSECTION=causes . Accessed May 26, 2009.

Last reviewed November 2012 by Igor Puzanov, MD

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