Accurate diagnosis and treatment of HIT and VITT under coagulopathy convergence model and clinical pathway transformation

ZHOU Yang; XIE Min

doi:10.3969/j.issn.1006-5725.2025.18.007

Abstract：The coagulopathy convergence model,by integrating the complex interplay among coagulation,inflammation,and innate immunity,offers novel insights into the intricate pathophysiology of heparin-induced thrombocytopenia(HIT)and vaccine-induced immune thrombotic thrombocytopenia(VITT),thereby facilitating their differential diagnosis and clinical management.This review systematically outlines the core pathophysiological differences between these two conditions within the framework of the model.Although both disorders involve a platelet factor 4(PF4)-dependent thrombotic pathway,they demonstrate notable differences in antibody profiles and mechanisms of immune amplification.Recent advances in diagnosis include the rapid diagnostic algorithm TORADI-HIT for HIT and the emerging clinical utility of neutrophil extracellular traps(NETs)as biomarkers for VITT.For refractory and severe cases,in addition to conventional anticoagulant and immunomodulatory therapies,model-guided targeted therapeutic strategies have become a focal point of research,including inhibition of NET formation(NETosis),blockade of the complement cascade,and modulation of FcγRⅡa signaling.The transla-tional potential of these strategies merits further investigation.Moreover,monitoring NET degradation products and complement activation fragments may aid in optimizing treatment and stratifying prognoses.This review proposes and visually illustrates an integrated"diagnosis-treatment-monitoring"clinical pathway for HIT and VITT,provid-ing a standardized approach for clinical application.The model highlights a key damage-associated molecular patterns(DAMPs)-NETs-immunothrombosis axis,which serves as a crucial framework for understanding and implementing stratified,precision-based interventions in these complex immune-mediated thrombotic disorders.