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Clinical presentation

• The importance of HIT is related to its paradoxical association with a very high risk of thromboembolic events². Therefore heparin, as an anticoagulant can, when HIT occurs, induce a highly thromboembolic state.



• These events include but are not confined to: - peripheral arterial occlusion - acute myocardial infarction - stroke⁴.



• The associated mortality with these events is high. In addition, venous thromboembolic disease (VTE) is very strongly associated with HIT⁵.



• The ratio of venous to arterial thrombotic events is approximately 4:1with pulmonary embolism (PE) occurring in approximately 25% of all patients diagnosed with HIT⁵.



• Other thrombotic manifestations of HIT are: - adrenal hemorrhagic necrosis, probably as a consequence of adrenal vein thrombosis⁶. - venous limb gangrene⁷. - Approximately 10-20% of patients develop limb-threatening ischaemia.



• Although co-morbid events related to underlying disorder complicate estimates of HIT-related mortality, it is thought that the overall HIT-associated mortality is approximately 20-30%⁵




What triggers HIT?



• The disorder is triggered by heparin regardless of dose or route of administration, including flushes administered to maintain patency of intravascular catheters.

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