Bilateral lower extremity compression ultrasonography may be considered in patients with HIT, whether or not there is clinical evidence of lower-limb DVT, because silent DVT is common and its presence may influence the recommended duration of anticoagulation.
For patients with HIT-associated thrombosis (i.e. HITT), anticoagulate for a defined course (typically 3 months) as with other provoked thromboses.
For patients with HIT without thrombosis (i.e. isolated HIT), the optimal duration of anticoagulation is unknown. Because there is an elevated risk of thrombosis extending 2 to 4 weeks after heparin is stopped, anticoagulation for up to 4 weeks should be considered.
For all patients, anticoagulation management should be based on an individualized risk/benefit assessment.