Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Heparin-induced thrombocytopenia: a renal perspective

Abstract

Heparin-induced thrombocytopenia (HIT) is a clinicopathologic syndrome in which one or more clinical events, usually thrombocytopenia or thrombosis, are temporally related to heparin administration and caused by HIT antibodies. Rapid and accurate diagnosis is essential given the high incidence of thrombosis at around the time of initial disease recognition. Discontinuation of heparin and initiation of alternative anticoagulants reduces HIT-associated morbidity and mortality. The clinical consequences of HIT in hemodialysis patients remain unclear, with several studies reporting no clinical sequelae and others describing complications such as thrombocytopenia or clotting of the extracorporeal circuit. Frequent clotting of the extracorporeal circuit has also been reported in HIT-antibody-positive patients on continuous veno-venous hemofiltration. Several recent findings are of particular interest to nephrologists. An acute systemic reaction has been described as a presentation of HIT in hemodialysis patients shortly after administration of an unfractionated heparin bolus. This syndrome is important to recognize as it might mimic a dialyzer reaction. More recently, the presence of a positive HIT-antibody test or increasing titers of HIT antibody were associated with increased mortality in hemodialysis patients, raising the question of whether these antibodies have a role in the increased cardiovascular mortality seen in these patients. HIT-antibody production is often transient and small numbers of hemodialysis patients with undetectable antibody levels have been rechallenged with heparin without adverse clinical consequences.

Key Points

  • Heparin-induced thrombocytopenia (HIT) is a clinicopathologic syndrome with one or more clinical events, usually thrombocytopenia or thrombosis, temporally related to heparin administration and caused by HIT antibodies

  • The traditional commercial ELISA cutoff value (≥0.4 optical density units) for a positive HIT-antibody test only diagnosed 50% of patients at high to intermediate risk of HIT correctly

  • An acute systemic reaction has been described as a presentation of HIT in hemodialysis patients shortly after administration of an unfractionated heparin bolus

  • The presence of a positive HIT-antibody test or increasing titers of HIT antibody is associated with increased mortality in hemodialysis patients

  • HIT-antibody production is often transient and small numbers of hemodialysis patients with a history of HIT and undetectable antibody levels have been rechallenged with heparin without adverse clinical consequences

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Ahmed, I., Majeed, A. & Powell, R. Heparin induced thrombocytopenia: diagnosis and management update. Postgrad. Med. J. 83, 575–582 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Weismann, R. E. & Tobin, R. W. Arterial embolism occurring during systemic heparin therapy. AMA Arch. Surgery 76, 219–225 (1958).

    Article  CAS  Google Scholar 

  3. Rhodes, G. R., Dixon, R. H. & Silver, D. Heparin induced thrombocytopenia with thrombotic and hemorrhagic manifestations. Surg. Gynecol. Obstet. 136, 409–416 (1973).

    CAS  PubMed  Google Scholar 

  4. Amiral, J. et al. Platelet factor 4 complexed to heparin is the target for antibodies generated in heparin-induced thrombocytopenia. Thromb. Haemost. 68, 95–96 (1992).

    Article  CAS  PubMed  Google Scholar 

  5. Reilly, R. F. The pathophysiology of immune-mediated heparin-induced thrombocytopenia. Semin. Dial. 16, 54–60 (2003).

    Article  PubMed  Google Scholar 

  6. Chuang, P., Parikh, C. & Reilly, R. F. A case review: anticoagulation in hemodialysis patients with heparin-induced thrombocytopenia. Am. J. Nephrol. 21, 226–231 (2001).

    Article  CAS  PubMed  Google Scholar 

  7. Chang, J. J. & Parikh, C. R. When heparin causes thrombosis: significance, recognition, and management of heparin-induced thrombocytopenia in dialysis patients. Semin. Dial. 19, 297–304 (2006).

    Article  PubMed  Google Scholar 

  8. Warkentin, T. E., Chong, B. H. & Greinacher, A. Heparin-induced thrombocytopenia: toward consensus. Thromb. Haemost. 79, 1–7 (1998).

    Article  CAS  PubMed  Google Scholar 

  9. Kelton, J. G. & Warkentin, T. E. Heparin-induced thrombocytopenia: a historical perspective. Blood 112, 2607–2615 (2008).

    Article  CAS  PubMed  Google Scholar 

  10. Warkentin, T. E. & Kelton, J. G. Delayed onset heparin-induced thrombocytopenia and thrombosis. Ann. Intern. Med. 135, 502–506 (2001).

    Article  CAS  PubMed  Google Scholar 

  11. Kelton, J. G., Hursting, M. J., Heddle, N. & Lewis, B. E. Predictors of clinical outcome in patients with heparin-induced thrombocytopenia treated with direct thrombin inhibition. Blood Coagul. Fibrinolysis 19, 471–475 (2008).

    Article  CAS  PubMed  Google Scholar 

  12. Warkentin, T. E. & Kelton, J. G. A 14-year study of heparin-induced thrombocytopenia. Am. J. Med. 101, 502–507 (1996).

    Article  CAS  PubMed  Google Scholar 

  13. Greinacher, A. et al. Clinical features of heparin-induced thrombocytopenia including risk factors for thrombosis: a retrospective analysis of 408 patients. Thromb. Haemost. 94, 132–135 (2005).

    Article  CAS  PubMed  Google Scholar 

  14. Preachel, M. & Walenga, J. The laboratory diagnosis and clinical management of patients with heparin-induced thrombocytopenia: an update. Semin. Thromb. Hemost. 34, 86–96 (2008).

    Article  CAS  Google Scholar 

  15. O' Toole, R. D. Heparin: adverse reaction. Ann. Intern. Med. 79, 759 (1973).

    Article  CAS  Google Scholar 

  16. Warkentin, T. E. et al. The pathogenesis of venous limb gangrene associated with heparin-induced thrombocytopenia. Ann. Intern. Med. 127, 804–812 (1997).

    Article  CAS  PubMed  Google Scholar 

  17. Warkentin, T. E. Clinical picture of heparin-induced thrombocytopenia. In Heparin-Induced Thrombocytopenia, 3rd edn (Eds Warkentin, T. E. & Greinacher, A.) 21–66 (Marcel Dekker, New York, 2007).

    Chapter  Google Scholar 

  18. Hartman, V., Malbrain, M., Daelemans, R., Meersman, P. & Zachée, P. Pseudo-pulmonary embolism as a sign of acute heparin-induced thrombocytopenia in hemodialysis patients: safety of resuming heparin after disappearance of HIT antibodies. Nephron Clin. Pract. 104, c143–c148 (2006).

    Article  CAS  PubMed  Google Scholar 

  19. Davenport, A. Sudden collapse during haemodialysis due to immune-mediated heparin-induced thrombocytopenia. Nephrol. Dial. Transplant. 21, 1721–1724 (2006).

    Article  PubMed  Google Scholar 

  20. Amiral, J. et al. Pathogenicity of IgA and/or IgM antibodies to heparin-PF4 complexes in patients with heparin-induced thrombocytopenia. Br. J. Haematol. 92, 954–959 (1996).

    Article  CAS  PubMed  Google Scholar 

  21. Kelton, J. G. et al. Immunoglobulin G from patients with heparin-induced thrombocytopenia binds to a complex of heparin and platelet factor 4. Blood 83, 3232–3239 (1994).

    CAS  PubMed  Google Scholar 

  22. Cines, D. B., Tomaski, A. & Tannenbaum, S. Immune endothelial-cell injury in heparin-associated thrombocytopenia. N. Engl. J. Med. 316, 581–589 (1987).

    Article  CAS  PubMed  Google Scholar 

  23. Blank, M. et al. Anti-platelet factor 4/heparin antibodies from patients with heparin-induced thrombocytopenia provoke direct activation of microvascular endothelial cells. Int. Immunol. 14, 121–129 (2002).

    Article  CAS  PubMed  Google Scholar 

  24. Warkentin, T. E. & Greinacher, A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention. Chest 126, 311S–337S (2004).

    Article  CAS  PubMed  Google Scholar 

  25. Warkentin, T. E., Aird, W. C. & Rand, J. H. Platelet-endothelial interactions: sepsis, HIT and antiphospholipid syndrome. Hematology Am. Soc. Hematol. Educ. Program 1, 497–519 (2003).

    Article  Google Scholar 

  26. Lo, G. K. et al. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J. Thromb. Haemost. 4, 759–765 (2006).

    Article  CAS  PubMed  Google Scholar 

  27. Pouplard, C. et al. Prospective evaluation of the “4Ts” score and particle gel immunoassay specific to heparin/PF4 for the diagnosis of heparin-induced thrombocytopenia. J. Thromb. Haemost. 5, 1373–1379 (2007).

    Article  CAS  PubMed  Google Scholar 

  28. Greinacher, A. et al. Laboratory diagnosis of heparin-associated thrombocytopenia and comparison of platelet aggregation test, heparin-induced platelet activation test, and platelet factor 4/heparin enzyme-linked immunosorbent assay. Transfusion 34, 381–385 (1994).

    Article  CAS  PubMed  Google Scholar 

  29. Alberio, L. Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment. Curr. Opin. Hematol. 15, 456–464 (2008).

    Article  CAS  PubMed  Google Scholar 

  30. Lo, G. K., Sigouin, C. S. & Warkentin, T. E. What is the potential for overdiagnosis of heparin-induced thrombocytopenia? Am. J. Hematol. 82, 1037–1043 (2007).

    Article  CAS  PubMed  Google Scholar 

  31. Warkentin, T. E. et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N. Engl. J. Med. 332, 1330–1335 (1995).

    Article  CAS  PubMed  Google Scholar 

  32. Prandoni, P., Siragusa, S., Girolami, B., Fabris, F. & BELZONI Investigators Group. The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecular-weight heparin: a prospective cohort study. Blood 106, 3049–3054 (2005).

    Article  CAS  PubMed  Google Scholar 

  33. Lee, D. P. & Warkentin, T. E. Frequency of heparin-induced thrombocytopenia. In Heparin-Induced Thrombocytopenia, 2nd edn (Eds Warkentin, T. E. & Greinacher, A.) 87–122 (Marcel Decker, New York, 2001).

    Google Scholar 

  34. Yamamoto, S. et al. Heparin-induced thrombocytopenia in hemodialysis patients. Am. J. Kidney Dis. 28, 82–85 (1996).

    Article  CAS  PubMed  Google Scholar 

  35. Greinacher, A., Zinn Wizemann, S. & Birk, U. W. Heparin-induced antibodies as a risk factor for thromboembolism and haemorrhage in patients undergoing chronic haemodialysis. Lancet 348, 764 (1996).

    Article  CAS  PubMed  Google Scholar 

  36. Sitter, T., Spannagl, M., Banas, B. & Schiffl, H. Prevalence of heparin-induced PF4-heparin antibodies in hemodialysis patients. Nephron 79, 245–246 (1998).

    Article  CAS  PubMed  Google Scholar 

  37. de Sancho, M., Lema, M. G., Amiral, J. & Rand, J. Frequencies of antibodies directed against heparin-platelet factor 4 in patients exposed to heparin through chronic hemodialysis. Thromb. Haemost. 75, 693–699 (1996).

    Google Scholar 

  38. Boon, D. M., van Vliet, H. H., Zietse, R. & Kappers-Klunne, M. C. The presence of antibodies against a PF4-heparin complex in patients on haemodialysis. Thromb. Haemost. 76, 480 (1996).

    Article  CAS  PubMed  Google Scholar 

  39. O'Shea, S. I., Sands, J. J., Nudo, S. A. & Ortel, T. L. Frequency of anti-heparin-platelet factor 4 antibodies in hemodialysis patients and correlation with recurrent vascular access thrombosis. Am. J. Hematol. 69, 72–73 (2002).

    Article  CAS  PubMed  Google Scholar 

  40. Matsuo, T. et al. Frequency of anti-heparin-PF4 complex antibodies (HIT antibodies) in uremic patients on chronic intermittent hemodialysis. Pathophysiol. Haemost. Thromb. 35, 445–450 (2006).

    Article  CAS  PubMed  Google Scholar 

  41. Yu, A., Jacobson, S. H., Bygdén, A. & Egberg, N. The presence of heparin-platelet factor 4 antibodies as a marker of hypercoagulability during hemodialysis. Clin. Chem. Lab. Med. 40, 21–26 (2002).

    Article  CAS  PubMed  Google Scholar 

  42. Carrier, M. et al. Increased mortality in hemodialysis patients having specific antibodies to the platelet factor 4-heparin complex. Kidney Int. 73, 213–219 (2008).

    Article  CAS  PubMed  Google Scholar 

  43. Luzzatto, G. et al. Platelet count, anti-heparin/platelet factor 4 antibodies and tissue factor pathway inhibitor plasma antigen level in chronic dialysis. Thromb. Res. 89, 115–122 (1998).

    Article  CAS  PubMed  Google Scholar 

  44. de la Vega, L. P. et al. Association of heparin-dependent antibodies and adverse outcomes in hemodialysis patients: a population-based study. Mayo Clin. Proc. 80, 995–1000 (2005).

    Article  Google Scholar 

  45. Mureebe, L. et al. Heparin-associated antiplatelet antibodies increase morbidity and mortality in hemodialysis patients. Surgery 136, 848–853 (2004).

    Article  PubMed  Google Scholar 

  46. Palomo, I. et al. Prevalence of heparin-induced antibodies in patients with chronic renal failure undergoing hemodialysis. J. Clin. Lab. Anal. 19, 189–195 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Nakamoto, H. et al. Role of platelet factor 4-heparin complex antibody (HIT antibody) in the pathogenesis of thrombotic episodes in patients on hemodialysis. Hemodial. Int. 9 (Suppl. 1), S2–S7 (2005).

    Article  PubMed  Google Scholar 

  48. Asmis, L. M. et al. Heparin-induced antibodies and cardiovascular risk in patients on dialysis. Thromb. Haemost. 100, 498–504 (2008).

    Article  CAS  PubMed  Google Scholar 

  49. Lasocki, S. et al. Anti-PF4/heparin antibodies associated with repeated hemofiltration-filter clotting: a retrospective study. Crit. Care 12, R84 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  50. Warkentin, T. E. & Kelton, J. G. A 14-year study of heparin-induced thrombocytopenia. Am. J. Med. 101, 502–507 (1996).

    Article  CAS  PubMed  Google Scholar 

  51. Moberg, P. Q., Geary, V. M. & Sheikh, F. M. Heparin-induced thrombocytopenia: a possible complication of heparin-coated pulmonary artery catheters. J. Cardiothorac. Anesth. 4, 226–228 (1990).

    Article  CAS  PubMed  Google Scholar 

  52. Kaplan, G. G., Manns, B. & McLaughlin, K. Heparin induced thrombocytopaenia secondary to intraperitoneal heparin exposure. Nephrol. Dial. Transplant. 20, 2561–2562 (2005).

    Article  PubMed  Google Scholar 

  53. Fischer, K. G. Hemodialysis in heparin-induced thrombocytopenia. In Heparin-Induced Thrombocytopenia, 3rd edn (Eds Warkentin, T. E. & Greinacher, A.) 463–485 (New York, Marcel Dekker, 2007).

    Chapter  Google Scholar 

  54. Nowak, G., Bucha, E., Gööck, T., Thieler, H. & Markwardt, F. Pharmacology of r-hirudin in renal impairment. Thromb. Res. 66, 707–715 (1992).

    Article  CAS  PubMed  Google Scholar 

  55. Keeling, D. et al. The management of heparin-induced thrombocytopenia. Br. J. Haematol. 133, 259–269 (2006).

    Article  CAS  PubMed  Google Scholar 

  56. Linkins, L. A. & Warkentin, T. E. The approach to heparin-induced thrombocytopenia. Semin. Respir. Crit. Care Med. 29, 66–74 (2008).

    Article  PubMed  Google Scholar 

  57. O'Shea, S. I., Ortel, T. L. & Kovalik, E. C. Alternative methods of anticoagulation for dialysis-dependent patients with heparin-induced thrombocytopenia. Semin. Dial. 16, 61–67 (2003).

    Article  PubMed  Google Scholar 

  58. Warkentin, T. E. et al. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133 (Suppl. 6), 340S–380S (2008).

    Article  CAS  PubMed  Google Scholar 

  59. Vanholder, R. et al. Pharmacokinetics of recombinant hirudin in hemodialyzed end-stage renal failure patients. Thromb. Haemost. 77, 650–655 (1997).

    Article  CAS  PubMed  Google Scholar 

  60. Greinacher, A., Eichler, P., Lubenow, N., Kwasny, H. & Luz, M. Heparin-induced thrombocytopenia with thromboembolic complications: meta-analysis of 2 prospective trials to assess the value of parenteral treatment with lepirudin and its therapeutic aPTT range. Blood 96, 846–851 (2000).

    CAS  PubMed  Google Scholar 

  61. Badger, N. O., Butler, K. & Hallman, L. C. Excessive anticoagulation and anaphylactic reaction after rechallenge with lepirudin in a patient with heparin-induced thrombocytopenia. Pharmacotherapy 24, 1800–1803 (2004).

    Article  PubMed  Google Scholar 

  62. Bauersachs, R. M. et al. Treatment of hirudin overdosage in a patient with chronic renal failure. Thromb. Haemost. 81, 323–324 (1999).

    Article  CAS  PubMed  Google Scholar 

  63. Frank, R. D., Farber, H., Stefanidis, I., Lanzmich, R. & Kierdorf, H. P. Hirudin elimination by hemofiltration: a comparative in vitro study of different membranes. Kidney Int. 56 (Suppl. 72s), S41–S45 (1999).

    Article  Google Scholar 

  64. Benz, K., Nauck, M. A., Böhler, J. & Fischer, K. G. Hemofiltration of recombinant hirudin by different hemodialyzer membranes: implications for clinical use. Clin. J. Am. Soc. Nephrol. 2, 470–476 (2007).

    Article  CAS  PubMed  Google Scholar 

  65. Lubenow, N. & Greinacher, A. Heparin-induced thrombocytopenia. Recommendations for optimal use of recombinant hirudin. Biodrugs 14, 109–125 (2000).

    Article  CAS  PubMed  Google Scholar 

  66. Nowak, G. & Bucha, E. Quantitative determination of hirudin in blood and body fluids. Semin. Thromb. Hemost. 22, 197–202 (1996).

    Article  CAS  PubMed  Google Scholar 

  67. Guy, S. et al. The use of ecarin chromogenic assay and prothrombin induced clotting time in the monitoring of lepirudin for treatment of heparin-induced thrombocytopenia. Br. J. Haematol. 142, 466–468 (2008).

    Article  CAS  PubMed  Google Scholar 

  68. Athar, U., Husain, J., Hudson, J., Lynch, J. & Gajra, A. Prolonged half-life of argatroban in patients with renal dysfunction and antiphospholipid antibody syndrome being treated for heparin-induced thrombocytopenia. Am. J. Hematol. 83, 245–246 (2008).

    Article  CAS  PubMed  Google Scholar 

  69. Di Nisio, M., Middeldorp, S. & Büller, H. R. Direct thrombin inhibitors. N. Engl. J. Med. 353, 1028–1040 (2005).

    Article  CAS  PubMed  Google Scholar 

  70. Lewis, B. E., Wallis, D. E., Hursting, M. J., Levine, R. L. & Leya, F. Effects of argatroban therapy, demographic variables, and platelet count on thrombotic risks in heparin-induced thrombocytopenia. Chest 129, 1407–1416 (2006).

    Article  CAS  PubMed  Google Scholar 

  71. Swan, S. W. & Hursting, M. J. The pharmacokinetics and pharmacodynamics of argatroban: effects of age, gender, and hepatic or renal dysfunction. Pharmacotherapy 20, 318–329 (2000).

    Article  CAS  PubMed  Google Scholar 

  72. Link, A. et al. Argatroban for anticoagulation in continuous renal replacement therapy. Crit. Care Med. 37, 105–110 (2009).

    Article  CAS  PubMed  Google Scholar 

  73. Murray, P. T. et al. A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease. Kidney Int. 66, 2446–2453 (2004).

    Article  CAS  PubMed  Google Scholar 

  74. Hursting, M. J. & Murray, P. T. Argatroban anticoagulation in renal dysfunction: a literature analysis. Nephron Clin. Pract. 109, c80–c94 (2008).

    Article  PubMed  Google Scholar 

  75. Schneider, S. A., Nauck, M. S., Nauck, M. A. & Fischer, K.-G. Only plasmapheresis allows for danaparoid elimination from blood [abstract]. Kidney Blood Press. Res. 27, a360 (2004).

    Google Scholar 

  76. Dager, W. E., Dougherty, J. A., Nguyen, P. H., Militello, M. A. & Smythe, M. A. Heparin-induced thrombocytopenia: treatment options and special considerations. Pharmacotherapy 27, 564–587 (2007).

    Article  CAS  PubMed  Google Scholar 

  77. Apsner, R., Buchmayer, H., Gruber, D. & Sunder-Plassmann, G. Citrate for long-term hemodialysis: prospective study of 1,009 consecutive high-flux treatments in 59 patients. Am. J. Kidney Dis. 45, 557–564 (2005).

    Article  CAS  PubMed  Google Scholar 

  78. Kozik-Jaromin, J., Nier, V., Heemann, U., Kreymann, B. & Böhler, J. Citrate pharmacokinetics and calcium levels during high-flux dialysis with regional citrate anticoagulation. Nephrol. Dial. Transplant. 24, 2244–2251 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Hartman, V., Malbrain, M., Daelemans, R., Meersman, P. & Zachée, P. Pseudo-pulmonary embolism as a sign of acute heparin-induced thrombocytopenia in hemodialysis patients: safety of resuming heparin after disappearance of HIT antibodies. Nephron Clin. Pract. 104, c143–c148 (2006).

    Article  CAS  PubMed  Google Scholar 

  80. Davenport, A. HIT on dialysis—when is it safe to rechallenge? Nephron Clin. Pract. 104, c149–c150 (2006).

    Article  PubMed  Google Scholar 

  81. Matsuo, T., Kusano, H., Wanaka, K., Ishihara, M. & Oyama, A. Heparin-induced thrombocytopenia in a uremic patient requiring hemodialysis: an alternative treatment and reexposure to heparin. Clin. Appl. Thromb. Haemost. 13, 182–187 (2007).

    Article  CAS  Google Scholar 

  82. Pötzsch, B., Klövekorn, W. P. & Madlener, K. Use of heparin during cardiopulmonary bypass in patients with a history of heparin-induced thrombocytopenia. N. Engl. J. Med. 343, 515 (2000).

    Article  PubMed  Google Scholar 

  83. Greinacher, A. The use of direct thrombin inhibitors in cardiovascular surgery in patients with heparin-induced thrombocytopenia. Semin. Thromb. Hemost. 30, 315–327 (2004).

    Article  CAS  PubMed  Google Scholar 

  84. Selleng, S., Lubenow, N., Wollert, H. G., Müllejans, B. & Greinacher, A. Emergency cardiopulmonary bypass in a bilaterally nephrectomized patient with a history of heparin-induced thrombocytopenia. Ann. Thorac. Surg. 71, 1041–1042 (2001).

    Article  CAS  PubMed  Google Scholar 

  85. Lubenow, N. et al. Heparin-induced thrombocytopenia and cardiopulmonary bypass: perioperative argatroban use. Ann. Thorac. Surg. 75, 577–579 (2003).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert F. Reilly.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Syed, S., Reilly, R. Heparin-induced thrombocytopenia: a renal perspective. Nat Rev Nephrol 5, 501–511 (2009). https://doi.org/10.1038/nrneph.2009.125

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneph.2009.125

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing