Burden of costs associated with heparin-induced thrombocytopenia: is time to remove unfractionated heparin from the drug formularies in medical institutions?

Heparin-induced thrombocytopenia (HIT) represents a serious complication of heparin therapy. Despite generally safe, heparin use can trigger a transient and life-threatening immune-mediated response in which immunoglobulin G antibodies set off immunological complexes against platelet factor 4 (PF4) (1). This determines a highly pro-thrombotic state through different pathways: intensive platelet aggregation, augmented thrombin generation and intravascular platelet aggregation.