A Novel Diagnostic Algorithm for Heparin-Induced Thrombocytopenia in a Retrospective Cohort of Lung Transplant Recipients. (March 2020)

• Record Type: Journal Article
• Authors: Small, Bronwyn Larissa; Gomes, Marcelo P.; McCurry, Kenneth R.; Han, Xiaozhen; Ataya, Ali; Akindipe, Olufemi; Lane, C. Randall; Budev, Marie
• Is Part Of: Progress in transplantation. Volume 30:Number 1(2020)
• Page Start: 4
• Page End: 12
• Publication Date: 2020-03
• Subjects: hemic and lymphatic diseases -- pathological conditions -- signs and symptoms -- heparin -- lung transplant -- thrombocytopenia; Transplantation of organs, tissues, etc -- Periodicals; Transplantation; Organ Procurement; Tissue Donors; Transplantation of organs, tissues, etc; Electronic journals; Periodicals; Periodicals; 362.1783
• DOI: 10.1177/1526924819892918
• Languages: English
• ISSNs: 1526-9248

Abstract

Introduction: Heparin-induced thrombocytopenia (HIT) is characterized by thrombocytopenia and potential for thromboembolism. Lung transplant recipients are at risk of developing HIT due to heparin exposure peritransplant. We describe the incidence and impact of HIT in lung transplant recipient index hospital length of stay and survival. Design: A retrospective cohort was obtained from electronic medical records which were queried for all recipients treated with bivalirudin (institutional treatment of choice for HIT) between January 1, 2005, and February 16, 2017 (N = 1171). Patients who developed HIT >30 days after transplant or after their index transplant admission were excluded. A diagnostic algorithm was used retrospectively to determine clinical HIT with an intermediate or high pretest clinical suspicion ("4T" score ≥4) and either (1) positive anti-heparin–platelet-factor 4 (HPF4) assay and a positive functional platelet assay or (2) a positive HPF4 assay only, in patients who did not undergo cardiopulmonary bypass. Results: Among all lung transplant recipients, 2.1% were found to develop HIT in the peritransplant period (N = 25, mean = 88%) with a mean lung allocation score of 50.8 and an incidence of venous thromboembolism of 72%, most upper extremity in location. When matched with historical controls, patients with HIT had a longer overall index hospital length of stay of 43 days ( P = .008). There was no difference in short- or long-term survival posttransplant. Conclusion: Vigilance for the development of HIT in lung transplant recipients is necessary to prevent further morbidity from thromboembolic events. In our cohort, HIT increased hospital length of stay but did not appear to affect recipient survival.