American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia
Top Cited Papers
Open Access
- 27 November 2018
- journal article
- research article
- Published by American Society of Hematology in Blood Advances
- Vol. 2 (22), 3360-3392
- https://doi.org/10.1182/bloodadvances.2018024489
Abstract
Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction mediated by platelet-activating antibodies that target complexes of platelet factor 4 and heparin. Patients are at markedly increased risk of thromboembolism. These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about diagnosis and management of HIT. ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. The panel agreed on 33 recommendations. The recommendations address screening of asymptomatic patients for HIT, diagnosis and initial management of patients with suspected HIT, treatment of acute HIT, and special situations in patients with acute HIT or a history of HIT, including cardiovascular surgery, percutaneous cardiovascular intervention, renal replacement therapy, and venous thromboembolism prophylaxis. Strong recommendations include use of the 4Ts score rather than a gestalt approach for estimating the pretest probability of HIT and avoidance of HIT laboratory testing and empiric treatment of HIT in patients with a low-probability 4Ts score. Conditional recommendations include the choice among non-heparin anticoagulants (argatroban, bivalirudin, danaparoid, fondaparinux, direct oral anticoagulants) for treatment of acute HIT.Keywords
This publication has 141 references indexed in Scilit:
- Guidelines on the diagnosis and management of heparin‐induced thrombocytopenia: second editionBritish Journal of Haematology, 2012
- PF4/heparin-antibody complex induces monocyte tissue factor expression and release of tissue factor positive microparticles by activation of FcγRIBlood, 2012
- Treatment and Prevention of Heparin-Induced Thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice GuidelinesSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- GRADE guidelines: 7. Rating the quality of evidence—inconsistencyJournal of Clinical Epidemiology, 2011
- The Vexing Problem of Guidelines and Conflict of Interest: A Potential SolutionAnnals of Internal Medicine, 2010
- Immune complexes formed following the binding of anti–platelet factor 4 (CXCL4) antibodies to CXCL4 stimulate human neutrophil activation and cell adhesionBlood, 2008
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendationsBMJ, 2008
- Pharmacokinetics and pharmacodynamics of danaparoid during continuous venovenous hemofiltration: a pilot studyCritical Care, 2007
- A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: The EVOLUTION-ON studyThe Journal of Thoracic and Cardiovascular Surgery, 2006
- Anticoagulation with bivalirudin for off-pump coronary artery bypass grafting: The results of the EVOLUTION-OFF studyThe Journal of Thoracic and Cardiovascular Surgery, 2006