Q; Q; Which intervention/drug can help when conventional treatments fail in cases with "Heparin Induced Thrombocytopenia (HIT) variants"?
Answer: Intravenous immune globulin (IVIG)
HIT variants is an umbrella term used for delayed onset, refractory or spontaneous HIT. These are severe and can be lethal clinical conditions, as patients continue to have all signs and symptoms of HIT even when heparin has been long withdrawn, other treatment modalities have been tried or even where there is no heparin exposure. These patients tend to have "HIT-like antibodies". IVIG is found to be effective in blocking further platelet activation in such situations. The recommended dose is 1 g/kg/day for two doses or 0.4 g/kg daily for five days. Please note anticoagulation with a non-heparin agent should be continued to reduce the risk of thrombosis.
#hematology
References:
1. Padmanabhan A, Jones CG, Pechauer SM, et al. IVIg for Treatment of Severe Refractory Heparin-Induced Thrombocytopenia. Chest 2017; 152:478.
2. Ibrahim IF, Rice L. Intravenous Immunoglobulin for Heparin-Induced Thrombocytopenia. Chest 2017; 152:906.
3. Azimov MB, Slater ED. Persistent Heparin-Induced Thrombocytopenia Treated With IVIg. Chest 2017; 152:679.
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