Incidence and clinical outcomes of heparin-induced thrombocytopenia: 11 year experience in a tertiary care university hospital
Abstract Heparin-induced thrombocytopenia (HIT) is a rare immuno-mediated adverse reaction with high thrombotic and mortality risk. To evaluate incidence and outcomes of HIT cases diagnosed at a tertiary care hospital from 2007 to 2018. A retrospective study was conducted. Patients with suspected HIT underwent 4Ts score assessment and anti-heparin PF4 IgG antibodies ELISA screening test. If the latter was positive, platelet aggregation test (PAT) was performed. If the latter was positive, any form of heparin was stopped, alternative anticoagulants were started and then overlapped with warfarin. HIT incidence was calculated by dividing HIT cases by the mean yearly number of admitted patients over 11 years. Follow-up was 90 days. Among 2125 screening tests, 96 (4.5%) were positive with confirmatory PAT in 82/90 (3.8% for missing data in 6). Median age was 75; 39 patients were surgical and 51 medical. The median 4Ts score was 5. Unfractionated heparin was employed in 34 (37%). HIT incidence was 0.16/1000/patient/years (95% CI: 0.12–0.23) in surgical and 0.15/1000/patient/years (95%: 0.12–0.20) in medical patients. HIT with thrombosis (HIT-T) was observed in 31 patients (0.05/1000/patient/years 95% CI: 0.04–0.1), with venous thromboses in 25 (80%). HIT without thrombosis was observed in 59 patients (0.1/1000 patient/years; 95% CI: 0.08–0.13, twofold vs HIT-T). All cause mortality was 25.5% (95% CI: 17.6–35.4), major bleeding 7.7% (95% CI:3.2–15.3), and thromboembolic complications 3.3% (95% CI:1.1–9.3). HIT is a rare event with high mortality, despite the use of non heparin anticoagulants..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
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| Enthalten in: |
Internal and emergency medicine - 18(2023), 7 vom: 12. Aug., Seite 1971-1980 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cosmi, Benilde [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Argatroban |
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| Anmerkungen: |
© The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1007/s11739-023-03379-5 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 520 | |a Abstract Heparin-induced thrombocytopenia (HIT) is a rare immuno-mediated adverse reaction with high thrombotic and mortality risk. To evaluate incidence and outcomes of HIT cases diagnosed at a tertiary care hospital from 2007 to 2018. A retrospective study was conducted. Patients with suspected HIT underwent 4Ts score assessment and anti-heparin PF4 IgG antibodies ELISA screening test. If the latter was positive, platelet aggregation test (PAT) was performed. If the latter was positive, any form of heparin was stopped, alternative anticoagulants were started and then overlapped with warfarin. HIT incidence was calculated by dividing HIT cases by the mean yearly number of admitted patients over 11 years. Follow-up was 90 days. Among 2125 screening tests, 96 (4.5%) were positive with confirmatory PAT in 82/90 (3.8% for missing data in 6). Median age was 75; 39 patients were surgical and 51 medical. The median 4Ts score was 5. Unfractionated heparin was employed in 34 (37%). HIT incidence was 0.16/1000/patient/years (95% CI: 0.12–0.23) in surgical and 0.15/1000/patient/years (95%: 0.12–0.20) in medical patients. HIT with thrombosis (HIT-T) was observed in 31 patients (0.05/1000/patient/years 95% CI: 0.04–0.1), with venous thromboses in 25 (80%). HIT without thrombosis was observed in 59 patients (0.1/1000 patient/years; 95% CI: 0.08–0.13, twofold vs HIT-T). All cause mortality was 25.5% (95% CI: 17.6–35.4), major bleeding 7.7% (95% CI:3.2–15.3), and thromboembolic complications 3.3% (95% CI:1.1–9.3). HIT is a rare event with high mortality, despite the use of non heparin anticoagulants. | ||
| 650 | 4 | |a Heparin |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Low molecular weight heparin |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Heparin-induced thrombocytopenia |7 (dpeaa)DE-He213 | |
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| 650 | 4 | |a Fondaparinux |7 (dpeaa)DE-He213 | |
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| 700 | 1 | |a Cini, Michela |4 aut | |
| 700 | 1 | |a Borgese, Laura |4 aut | |
| 700 | 1 | |a Sartori, Michelangelo |4 aut | |
| 700 | 1 | |a Palareti, Gualtiero |4 aut | |
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