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Screening frequency, incidence and pattern of heparin-induced thrombocytopenia syndrome at a large tertiary institution

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Abstract

Increasing awareness and availability of tests for anti-PF4/heparin complex antibodies has raised concerns about indiscriminate testing and inappropriate diagnosis of heparin-induced thrombocytopenia. A retrospective review of HITS testing at a large tertiary centre was performed to determine test patterns and incidence of HITS. Records of anti-PF4 tests over 4 years were reviewed. Positive results were matched against patient medical records and records of heparin utilisation for the diagnosis of HITS. Total of 33,308 patients (9.89 % of admissions) were exposed to at least 1 day of unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Of 346 anti-PF4 antibody assays performed, 52 (15 %) were positive. Seventeen patients (4.9 % of total) were determined to have HITS. Of these, 13 cases (76 %) were patients who were initiated on haemodialysis via central venous catheters. Five patients (29 %) subsequently experienced thrombosis. The rate of HITS in patients given UFH was 0.33 %. HITS occurred in only one patient given LMWH. Of 1337 patients with chronic renal failure initiated on long term haemodialysis, the incidence of HITS was 0.97 %. Despite increased awareness of HITS, testing frequency remains conservative. An overwhelming majority of HITS cases were diagnosed among patients initiated on haemodialysis.

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References

  1. Rhodes GR, Dixon RH, Silver D. Heparin induced thrombocytopenia with thrombotic and hemorrhagic manifestations. Surg Gynecol Obstet. 1973;136(3):409–16.

    CAS  PubMed  Google Scholar 

  2. Kelton JG, Warkentin TE. Heparin-induced thrombocytopenia: a historical perspective. Blood. 2008;112(7):2607–16.

    Article  CAS  PubMed  Google Scholar 

  3. Warkentin TE, Kelton JG. A 14-year study of heparin-induced thrombocytopenia. Am J Med. 1996;101(5):502–7.

    Article  CAS  PubMed  Google Scholar 

  4. Tapan U, Bolla S, Daglilar ES, Chang S, Kozyreva O. Outcome of patients with positive heparin-platelet factor-4 antibodies: a retrospective multi-institutional observational study. Platelets. 2015;26(7):661–4.

    Article  CAS  PubMed  Google Scholar 

  5. Rauova L, Zhai L, Kowalska MA, Arepally GM, Cines DB, Poncz M. Role of platelet surface PF4 antigenic complexes in heparin-induced thrombocytopenia pathogenesis: diagnostic and therapeutic implications. Blood. 2006;107(6):2346–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Padmanabhan A, Jones CG, Bougie DW, Curtis BR, McFarland JG, Wang D, et al. Heparin-independent, PF4-dependent binding of HIT antibodies to platelets: implications for HIT pathogenesis. Blood. 2015;125(1):155–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Greinacher A, Juhl D, Strobel U, Wessel A, Lubenow N, Selleng K, et al. Heparin-induced thrombocytopenia: a prospective study on the incidence, platelet-activating capacity and clinical significance of antiplatelet factor 4/heparin antibodies of the IgG, IgM, and IgA classes. J Thromb Haemost. 2007;5(8):1666–73.

    Article  CAS  PubMed  Google Scholar 

  8. Cines DB, Rauova L, Arepally G, Reilly MP, McKenzie SE, Sachais BS, et al. Heparin-induced thrombocytopenia: an autoimmune disorder regulated through dynamic autoantigen assembly/disassembly. J Clin Apher. 2007;22(1):31–6.

    Article  PubMed  Google Scholar 

  9. Warkentin TE, Sheppard JA, Moore JC, Moore KM, Sigouin CS, Kelton JG. Laboratory testing for the antibodies that cause heparin-induced thrombocytopenia: how much class do we need? J Lab Clin Med. 2005;146(6):341–6.

    Article  CAS  PubMed  Google Scholar 

  10. Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005;106(8):2710–5.

    Article  CAS  PubMed  Google Scholar 

  11. Prandoni P, Siragusa S, Girolami B, Fabris F, Group BI. The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecular-weight heparin: a prospective cohort study. Blood. 2005;106(9):3049–54.

    Article  Google Scholar 

  12. Girolami B, Prandoni P, Stefani PM, Tanduo C, Sabbion P, Eichler P, et al. The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study. Blood. 2003;101(8):2955–9.

    Article  CAS  PubMed  Google Scholar 

  13. Greinacher A, Alban S, Omer-Adam MA, Weitschies W, Warkentin TE. Heparin-induced thrombocytopenia: a stoichiometry-based model to explain the differing immunogenicities of unfractionated heparin, low-molecular-weight heparin, and fondaparinux in different clinical settings. Thromb Res. 2008;122(2):211–20.

    Article  CAS  PubMed  Google Scholar 

  14. Locke CF, Dooley J, Gerber J. Rates of clinically apparent heparin-induced thrombocytopenia for unfractionated heparin vs. low molecular weight heparin in non-surgical patients are low and similar. Thromb J. 2005;3(1):4.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Warkentin TE, Cook RJ, Marder VJ, Greinacher A. Anti-PF4/heparin antibody formation postorthopedic surgery thromboprophylaxis: the role of non-drug risk factors and evidence for a stoichiometry-based model of immunization. J Thromb Haemost. 2010;8(3):504–12.

    Article  CAS  PubMed  Google Scholar 

  16. Chong BH, Burgess J, Ismail F. The clinical usefulness of the platelet aggregation test for the diagnosis of heparin-induced thrombocytopenia. Thromb Haemost. 1993;69(4):344–50.

    CAS  PubMed  Google Scholar 

  17. Harenberg J, Huhle G, Giese C, Wang LC, Feuring M, Song XH, et al. Determination of serotonin release from platelets by enzyme immunoassay in the diagnosis of heparin-induced thrombocytopenia. Br J Haematol. 2000;109(1):182–6.

    Article  CAS  PubMed  Google Scholar 

  18. Cuker A. Heparin-induced thrombocytopenia (HIT) in 2011: an epidemic of overdiagnosis. Thromb Haemost. 2011;106(6):993–4.

    Article  CAS  PubMed  Google Scholar 

  19. Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, et al. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis, 9th edn, American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e495S–530S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Warkentin TE, Greinacher A, Gruel Y, Aster RH, Chong BH. Haemostasis sascotisota. Laboratory testing for heparin-induced thrombocytopenia: a conceptual framework and implications for diagnosis. J Thromb Haemost. 2011;9(12):2498–500.

    Article  CAS  PubMed  Google Scholar 

  21. Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006;4(4):759–65.

    Article  CAS  PubMed  Google Scholar 

  22. Warkentin TE, Sheppard JI, Moore JC, Sigouin CS, Kelton JG. Quantitative interpretation of optical density measurements using PF4-dependent enzyme-immunoassays. J Thromb Haemost. 2008;6(8):1304–12.

    Article  CAS  PubMed  Google Scholar 

  23. Chan CM, Woods CJ, Warkentin TE, Sheppard JA, Shorr AF. The role for optical density in heparin-induced thrombocytopenia: a cohort study. Chest. 2015;148(1):55–61.

    Article  PubMed  Google Scholar 

  24. Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387–94.

    Article  PubMed  Google Scholar 

  25. Smythe MA, Koerber JM, Mattson JC. The incidence of recognized heparin-induced thrombocytopenia in a large, tertiary care teaching hospital. Chest. 2007;131(6):1644–9.

    Article  PubMed  Google Scholar 

  26. Carrier M, Knoll GA, Kovacs MJ, Moore JC, Fergusson D, Rodger MA. The prevalence of antibodies to the platelet factor 4 -heparin complex and association with access thrombosis in patients on chronic hemodialysis. Thromb Res. 2007;120(2):215–20.

    Article  CAS  PubMed  Google Scholar 

  27. Palomo I, Pereira J, Alarcón M, Díaz G, Hidalgo P, Pizarro I, et al. Prevalence of heparin-induced antibodies in patients with chronic renal failure undergoing hemodialysis. J Clin Lab Anal. 2005;19(5):189–95.

    Article  CAS  PubMed  Google Scholar 

  28. Zhao D, Sun X, Yao L, Lin H, Li J, Zhao J, et al. The clinical significance and risk factors of anti-platelet factor 4/heparin antibody on maintenance hemodialysis patients: a two-year prospective follow-up. PLoS One. 2013;8(4):e62239.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Chan KM, Cheung CY, Chau KF. Heparin-induced thrombocytopenia due to heparin lock in a hemodialysis patient: a case report. Hemodial Int. 2014;18(2):555–8.

    Article  PubMed  Google Scholar 

  30. Ng HJ, Than H, Teo EC. First experiences with the use of rivaroxaban in the treatment of heparin-induced thrombocytopenia. Thromb Res. 2015;135(1):205–7.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Hae Tha Mya.

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Mya, H.T., Tay, H.M., Gan, S.W. et al. Screening frequency, incidence and pattern of heparin-induced thrombocytopenia syndrome at a large tertiary institution. Int J Hematol 104, 92–98 (2016). https://doi.org/10.1007/s12185-016-2013-3

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  • DOI: https://doi.org/10.1007/s12185-016-2013-3

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