[Management of a suspicion of heparin-induced thrombopenia]

A COMPLEX SITUATION: During the acute phase of heparin-induced thrombocytopenia, the question must be raised as to whether an antithrombotic therapy is to be continued using a compound other than heparin. Later the risk of reintroducing heparin again can be discussed. THERAPEUTIC PROPOSITIONS: Excepting vena cava interruption, surgical revascularization and thrombolysis, possible therapeutic propositions can be divided into two categories; anticoagulants and related compounds (hirudin); and oral anticoagulants (anti-vitamin K) and antiplatelet agents (aspirin for example). Low molecular-weight heparin cannot be recommended in 1998 in patients with heparin-induced thrombocytopenia due to standard heparin.

Unfractionated heparin or low-molecular weight heparin must be stopped immediately. The hematology laboratory should be consulted. It must be remembered that prevention, based on a careful assessment of the benefit/risk ratio when initiating heparin therapy, is essential.