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Systematic review on heparin‐induced thrombocytopenia in children: a call to action
Author(s) -
Avila M. L.,
Shah V.,
Brandão L. R.
Publication year - 2013
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.12153
Subject(s) - medicine , incidence (geometry) , seroconversion , pediatrics , population , medline , heparin induced thrombocytopenia , intensive care medicine , emergency medicine , heparin , family medicine , physics , environmental health , human immunodeficiency virus (hiv) , political science , law , optics
Summary Background Heparin‐induced thrombocytopenia ( HIT ) has increasingly been reported in children as an indication for use of new alternative anticoagulant drugs ( NAAD s). Objectives To systematically review the literature regarding: (i) the incidence and prevalence of seroconversion and HIT and (ii) the clinical/laboratory findings and management of HIT in children. Design/Methods MEDLINE and EMBASE databases were searched for studies that reported pediatric cases of HIT . Methodological reliability assessment of studies was performed with the L oney scale. Results The incidence of seroconversion in neonates ranged between 0% and 1.7%. There were no cases of neonatal HIT in the included cohorts. The incidence range of seroconversion in the non‐neonatal population was 1.3–52%. The incidence of HIT in non‐neonates after cardiopulmonary bypass was 0.33% (95% CI , < 0.01–2.04). Whereas more than half of pediatric cases labeled as HIT (30/52) did not include pivotal features of this syndrome, 80% of them received NAAD s. Conclusion The incidence of HIT is likely to have been overestimated in children, leading to potential misuse of NAAD s in many cases. Clinical findings and laboratory assessment of pediatric cases are poorly described in the literature at present. Thorough laboratory investigation, proper reporting of cases and adequate design of studies are mandatory to elucidate the clinical/laboratory picture of pediatric HIT .