肝素诱导血小板减少症(heparin-induced thrombocytopenia,HIT)是肝素类药物使用过程中发生的免疫介导性不良反应，以血小板计数下降和/或血栓形成为特征。血液透析(hemodialysis,HD)患者因长期、反复暴露于肝素类药物，HIT发生风险可能高于普通人群，且更易发生致命性血栓事件。然而，目前国内外尚缺乏针对HD人群HIT管理的专家共识或指南，临床实践中存在检测能力不足、诊断困难、治疗策略不统一等突出问题。为此，本共识由肾内科、心血管内科及药学等多学科专家组成编写委员会，基于推荐分级的评估、制定与评价(the Grading of Recommendations Assessment，Development and Evaluation,GRADE)分级方法和德尔菲法专家投票，系统整合国内外HIT相关循证医学证据及HD临床实践经验，围绕HIT的定义、危险因素、发病机制、临床表现、诊断与鉴别诊断、筛查策略、抗凝治疗及监测、特殊治疗及肝素再暴露管理等方面，制定了适用于HD人群HIT防治的推荐意见。本共识旨在为HD患者HIT的规范化防治提供循证依据，提升临床医务人员对该疾病的认识与警惕性，降低漏诊率和血栓栓塞相关死亡率，改善患者预后。

Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction occurring during the use of heparin-based drugs, characterized by a decline in platelet count and/or thrombosis. Patients undergoing hemodialysis (HD) may be at higher risk of developing HIT than the general population due to long-term, repeated exposure to heparin preparations, and are more prone to life-threatening thrombotic events. However, there is currently no specific consensus or guideline for the management of HIT in the HD population either domestically or internationally, leading to difficulties in diagnosis, insufficient testing capacity, and inconsistent treatment strategies in clinical practice. To address these issues, a multidisciplinary expert committee comprising nephrologists, cardiovascular physicians, and clinical pharmacists developed recommendations for the prevention and treatment of HIT specifically applicable to the HD population. Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and Delphi method expert voting, the committee systematically integrated domestic and international evidence-based medicine on HIT and clinical experience in HD. The recommendations cover the definition, risk factors, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, screening strategies, anticoagulation therapy and monitoring, special treatments, and management of heparin re-exposure. This consensus aims to provide evidence-based guidance for standardized HIT management in HD patients, enhance clinical awareness and vigilance of the disease, reduce the rate of missed diagnosis and thrombotic mortality, and ultimately improve patient outcomes.