An anesthesia provider's perspective of heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is a pathology manifested as clinically induced destruction of platelets. There are 2 forms of HIT, type I and type II; type II is the more serious. HIT type I is a transient, non-immune-mediated form manifesting with mild thrombocytopenia. Type II is a drug-induced, immune-mediated syndrome that may cause life- or limb-threatening thromboembolic events. Induction of general anesthesia for a person with HIT type II is no different from that for a person in the general population. Treatment modalities vary only if heparin will be used during the case. The initial indicator of HIT is decreased platelet count, with or without thrombosis. Clinical criteria and advanced serological testing are available for the definitive diagnosis of HIT. Clinical suspicion of HIT remains key to early cessation of heparin (all routes) and initiation of alternative treatments.