Background: Clinicians confront heparin-induced thrombocytopenia (HIT) as the most pertinent pathological relationship. Antibodies directed against complexes of heparin molecules and platelet factor 4 (PF4) are the cause of this immune-mediated phenomena. HIT is a significant adverse event that affects individuals with acute coronary syndromes (ACS). Objective: To assess the frequency of HIT in patients presenting with ACS. Materials and Methods: This study was carried out the Northeast Medical College's Department of Cardiology in Sylhet from June 2021 to December 2022. A total of 234 individuals aged 40 to 70 years old presented with ACS within 24 hours of symptom onset. This study excluded patients with idiopathic thrombocytopenic purpura (ITP), aplastic anemia, myeloproliferative diseases, or pre-existing thrombocytopenia. Thrombocytopenia was evaluated using medical records and a full blood count (CBC), with isolated thrombocytopenia (platelets <150 x109/L) prior to heparin administration. Results: Diabetes mellitus, hypertension, a history of ACS, and obesity were the most frequent comorbidities, accounting for 41.03%, 33.76%, 43.16%, and 14.96%, respectively. The incidence of HIT in NSTEMI and STEMI was higher than in unstable angina, although still comparable. The delayed presentation of ACS > 12 hours was also strongly correlated with the occurrence of HIT (p<0.05). Unstable angina and middle age (50–60 years) were found to have a significant relationship with HIT (p<0.05). Conclusion: HIT is more common in patients who have had a myocardial infarction or who have had symptoms for more than 12 hours at the time of hospitalization. Cardiologists and internal medicine experts must take extra precautions when administering heparin to high-risk patients to prevent problems.