Heparin-Induced Thrombocytopenia

Abstract

To the Editor: Recently, on the basis of an intermediate-probability 4T score and a positive anti–PF4–heparin particle-gel immunoassay, a patient in our hospital who received low-molecular-weight heparin for thromboprophylaxis was suspected to have heparin-induced thrombocytopenia (HIT) without thrombosis. Greinacher (July 16 issue)¹ recommends the use of alternative, therapeutic-dose anticoagulants in such patients, but data to support therapeutic doses rather than prophylactic doses of anticoagulants are limited. Greinacher refers to a nonrandomized retrospective study² that suggested an improved outcome with therapeutic doses of danaparoid but not with lepirudin. In addition to this study, there are some small, mainly retrospective studies, all . . .