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Clinical outcomes in a cohort of patients with heparin‐induced thrombocytopenia
Author(s) -
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.
Publication year - 2017
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.24759
Subject(s) - medicine , gangrene , heparin , thrombosis , heparin induced thrombocytopenia , clinical endpoint , amputation , anticoagulant , surgery , platelet , gastroenterology , clinical trial
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.