PRINCIPAIS LINHAS TERAPÊUTICAS PARA A TROMBOCITOPENIA INDUZIDA POR HEPARINA (TIH): UMA REVISÃO DE LITERATURA

Abstract

Heparin-Induced Thrombocytopenia (HIT) is a complication of heparin use that occurs in a portion of patients undergoing this therapy. It is estimated that approximately one in 40 patients receiving unfractionated heparin and one in 500 patients receiving low molecular weight heparin develop HIT. Some factors can increase the frequency of HIT, such as surgery, use of unfractionated heparin, dose, age and gender. HIT can manifest itself with a reduction in platelet levels, thrombosis and systemic reactions. It is important to recognize HIT and institute treatment early to prevent possible complications. Treatment consists of discontinuing heparin and using non-heparin anticoagulants. The comparative effectiveness and safety of anticoagulants for the treatment of HIT remain under constant analysis of evidence. Therefore, the aim of this study is to carry out a literature review regarding the treatment of thrombocytopenia induced by the use of heparin. A search was carried out in the PUBMED and SCOPUS electronic databases with the Medical Subject Headings (MeSH): “Heparin”, “Heparin-induced thrombocytopenia” and “Treatment”. Articles published in the last 10 years, freely available and that are suitable for the objective of this study were selected. Subsequently, the articles were tabulated in the Microsoft Excel program and the findings of each article selected in the final sample were compiled in this review, being discussed in accordance with the literature. The review demonstrated that full anticoagulation is essential for patients who have a high suspicion of HIT defined by probability scores, such as the 4Ts score. The efficacy and safety of non-heparin anticoagulants is similar among the drugs studied. More studies are needed to define the best therapeutic strategy in specific groups of patients, such as surgical patients, immunosuppressed patients, dialysis patients or those requiring cardiopulmonary bypass.

KEYWORDS: Heparin-induced thrombocytopenia. Treatment.