Heparin-induced thrombocytopenia: a clinical and economic review

Introduction Heparin-induced thrombocytopenia is a serious immune-mediated, drug adverse effect. Research over the last 20 years has vastly expanded knowledge, awareness and management of this condition. This review includes findings mostly from primary source clinical and economic literature from this time period to synthesise a concise summary. We have highlighted key points regarding the pathophysiology, epidemiology and presentation, diagnosis and management, as well as the economic impact of heparin-induced thrombocytopenia. It is established that heparininduced thrombocytopenia is relatively uncommon overall, despite the widespread use of heparin. However, delayed recognition leads to significantly increased morbidity, mortality and disability. Treatment requires prolonged courses of expensive alternative anticoagulants. All of these impose substantial costs to patients, hospitals and society. The aim of this review was to assess the clinical and economic factors influencing heparin-induced thrombocytopenia. Conclusion Heparin-induced thrombocytopenia remains a significant clinical problem and is associated with morbidity, mortality and disability. Using heparin products can reduce (but not eliminate) the incidence of heparininduced thrombocytopenia. Properly administered treatment with factor Xa inhibitors or direct thrombin inhibitors can significantly decrease the direst complications of this condition and mitigate its economic impact.