Management of perioperative anticoagulation for patients with HIT undergoing cardiac or vascular surgery

Close consultation between the surgeon, anesthesia team, and hematologist or laboratory medicine specialist is advised. Details of platelet count monitoring are discussed in UpToDate. Unnecessary heparin should be avoided in all patients with a history of HIT regardless of current laboratory testing results. No heparin flushes should be used, and if postoperative anticoagulation is needed, a non-heparin agent should be used. Postoperative platelet counts and the clinical probability of HIT (eg, based on the 4 Ts score) are used to determine the need for postoperative PF4/heparin antibody testing. Refer to UpToDate for additional details of the evaluation and management of HIT and details of the interventions listed above.