Strategies in heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is an uncommon condition that may confront cardio-thoracic surgeons with difficult problems. The underlying cause of HIT is the formation of antibodies against platelet factor 4/heparin complexes, leading to platelet activation and intravascular platelet aggregation. HIT occurs following heparin administration usually with a time delay of 5-10 days. Clinical suspicion and laboratory tests for platelet-activating antibodies are the cornerstone of diagnosis. Appropriate strategies in HIT are stopping heparin and use of alternative anticoagulants. In addition, surgery with extracorporeal circulation (ECC) should be postponed whenever possible or alternative anticoagulants have to be used during ECC.