How do you approach anticoagulation in the setting of HIT and thrombocytopenia?

This is a very relevant but rather broad question. On a day-to-day basis, the decision on whether one is dealing with HIT vs other causes of thrombocytopenia can be complex. Applying the 4Ts score is easier in retrospect, but in real life patient management, the score has the potential to change almost on a daily basis. With that as a background, for a platelet count of less than 30,000, I would carefully assess for bleeding symptoms. If the patient has no bleeding symptoms/signs, then one is most likely dealing with HIT, and anticoagulation with a DTI may need to be strongly considered with careful monitoring for bleeding. Use of DTI in bonafide HIT even in the setting of moderate to severe thrombocytopenia generally does not consistently ...