Pharmacotherapy of heparin-induced thrombocytopenia: Therapeutic options and challenges in the clinical practices

• Heparin-induced thrombocytopenia (HIT) is an immune response results from exposure to heparin or low-molecular weight heparin (LMWH).
• Early diagnosis based on clinical evaluation improves clinical outcomes.
• Once HIT is suspected, all heparin forms and LMWH must be discontinued.
• Nonheparin anticoagulant should be considered to prevent HIT complications.

Heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated with significant morbidity and mortality in hospitalized patients if unidentified as soon as possible, owing to thromboembolic complications involving both arterial and venous systems. Early diagnoses based on a comprehensive interpretation of clinical and laboratory information improves clinical outcomes. Management principles of strongly suspected HIT should not be delayed for laboratory result confirmation. Treatment strategies have been introduced including new, safe, and effective agents. This review summarizes the clinical therapeutic options for HIT addressing the use of parenteral direct thrombin inhibitors and indirect factor Xa inhibitors as well as the potential non-vitamin K antagonist oral anticoagulants.