Heparin-induced thrombocytopenia: a challenging diagnosis in haemodialysis—state of art and review of the literature

Heparin-induced thrombocytopenia (HIT) is a life-threatening disorder caused by exposure to heparin and characterized by high morbidity and mortality. It is largely underestimated because of its heterogeneous presentation, ranging from a decrease in platelet count antibody positivity to serious thrombotic complications. Haemodialysis (HD) patients represent a high-risk population due to anticoagulation use during extracorporeal treatments. It usually occurs in the first weeks after the start of HD, although it has been reported in chronic HD patients after surgery procedures. When the diagnosis of HIT is formulated, heparin must be promptly stopped and an alternative anticoagulant has to be started. The aim of this review is to provide a comprehensive overview on the pathogenesis, diagnosis and treatment of HIT in HD in order to increase the awareness of physicians of this important clinical syndrome to promptly start the specific treatment.