Hutchison CA and Dasgupta I (2007) National survey of heparin-induced thrombocytopenia in the haemodialysis population of the UK population. Nephrol Dial Transplant 22: 1680–1684

The use of heparin to prevent coagulation in the extrarenal circuit during hemodialysis has potential complications. The frequency and treatment patterns of heparin-induced thrombocytopenia (HIT) type II in the UK hemodialysis population had not been assessed in a large-scale study. By distributing a questionnaire to all 81 UK renal units, Hutchison and Dasgupta have been able to carry out such an evaluation.

Responses to the questionnaire were received from 50 (61.7%) units, representing a total of 10,564 maintenance hemodialysis patients. The observed overall prevalence of HIT type II was 0.26 per 100 patients, and the overall incidence was 0.32 per 100 patient-years. Fourteen of the responding units reported cases of HIT type II, with prevalences ranging from 0.22 to 1.74 per 100 patients. Only 17% of affected patients suffered complications.

Of the 50 renal units, 36% reported a policy of using danaparoid for ongoing anticoagulation in hemodialysis patients with HIT type II, as recommended by British Committee for Standards in Haematology guidelines. Worryingly, 6% of units continued to use low-molecular-weight heparin for anticoagulation in patients with HIT type II, and 34% of units had no defined policy for management of this condition.

This study shows HIT type II to be less prevalent in maintenance hemodialysis populations than previously estimated, and highlights the need for more-widespread implementation of management guidelines.