Clinical outcomes in a cohort of patients with heparin‐induced thrombocytopenia. Issue 8 (26th April 2017)

• Record Type: Journal Article
• Authors: Kuter, David J.; Konkle, Barbara A.; Hamza, Taye H.; Uhl, Lynne; Assmann, Susan F.; Kiss, Joseph E.; Kaufman, Richard M.; Key, Nigel S.; Sachais, Bruce S.; Hess, John R.; Ness, Paul; McCrae, Keith R.; Leissinger, Cindy; Strauss, Ronald G.; McFarland, Janice G.; Neufeld, Ellis; Bussel, James B.; Ortel, Thomas L.
• Is Part Of: American journal of hematology. Volume 92:Issue 8(2017:Aug.)
• Page Start: 730
• Page End: 738
• Publication Date: 2017-04-26
• Subjects: Hematology -- Periodicals; 616.15
• DOI: 10.1002/ajh.24759
• Languages: English
• ISSNs: 0361-8609

Abstract

Abstract: Background: Heparin‐induced thrombocytopenia (HIT) is a thrombotic disorder usually prompting treatment with non‐heparin anticoagulants. The benefits and risks of such treatments have not been fully assessed. Methods: We analyzed data for 442 patients having a positive heparin‐platelet factor 4 antibody test and recent heparin exposure. The primary outcome was a composite endpoint (death, limb amputation/gangrene, or new thrombosis). Secondary outcomes included bleeding and the effect of anticoagulation. Findings: Seventy‐one patients (16%) had HIT with thrombosis (HIT‐T); 284 (64%) had HIT without thrombosis (isolated HIT); 87 (20%) did not have HIT. An intermediate or high "4T" score was found in 85%, 58%, and 8% of the three respective groups. Non‐heparin anticoagulation was begun in 80%, 56%, and 45%. The composite endpoint occurred in 48%, 36%, and 17% ( P = .01) of which 61%, 38%, and 40% were receiving non‐heparin anticoagulation. Compared with the no HIT group, the composite endpoint was significantly more likely in HIT‐T [HR 2.48 (1.35‐4.55), P = .003)] and marginally more likely in isolated HIT [HR 1.66 (0.96‐2.85), P = .071]. Importantly, risk increased (HR 1.77, P = .02) after platelet transfusion. Major bleeding occurred in 48%, 36%, and 16% of the three groups ( P = .005). Non‐heparin anticoagulation was not associated with a reduction in composite endpoint events in either HIT group. Interpretation: HIT patients have high risks of death, limb amputation/gangrene, thrombosis, and bleeding. Non‐heparin anticoagulant treatment may not benefit all patients and should be considered only after careful assessment of the relative risks of thrombosis and bleeding in individual patients.