Decision Analysis for Use of Platelet Aggregation Test, Carbon 14–Serotonin Release Assay, and Heparin–Platelet Factor 4 Enzyme-Linked Immunosorbent Assay for Diagnosis of Heparin-lnduced Thrombocytopenia

Pouplard, Claire; Amiral, Jean; Borg, Jeanne‐Yvonne; Laporte-Simitsidis, S.; Delahousse, B.; Gruel, Yves

doi:10.1093/ajcp/111.5.700

Cited by 177 publications

(170 citation statements)

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“…However, if two tests are both negative, the likelihood of the diagnosis decreases to a large extent [17], as was the case for the 3 patients reported here. Moreover, immunologic heparin-induced thrombocytopenia (often referred to as type II HIT) could be definitely excluded because the patients' platelet counts recovered while they were given unfractionated heparin again.…”

Section: Discussionsupporting

confidence: 65%

Practical approach to the diagnosis and management of thrombocytopenia associated with tirofiban treatment

et al. 2004

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Anti-GPIIb/IIIa associated thrombocytopenia has been reported in most large trials, but very little data is available regarding tirofiban. We report three cases of thrombocytopenia, most likely attributed to tirofiban (two moderate and one severe). For each patient, laboratory investigation has allowed us to exclude another cause of thrombocytopenia, particularly heparin-induced thrombocytopenia. Platelet count recovery could be earlier with tirofiban than with abciximab. Some suggestions are proposed for practical management of these patients with persistent thrombotic risk, who are sometimes candidates for cardiopulmonary bypass surgery. Am.

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Section: Discussionsupporting

confidence: 65%

Practical approach to the diagnosis and management of thrombocytopenia associated with tirofiban treatment

et al. 2004

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“…We have seen patients with well-documented HIT, some with thrombosis, who were positive in the ELISA but negative in the SRA. Accordingly, judicious use of both types of assay is probably optimal for patient management [37,40,48].…”

Section: Serotonin Release Assay (Sra)mentioning

confidence: 99%

Heparin‐induced thrombocytopenia and thrombosis

Davoren

Aster

2005

American J Hematol

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Heparin, employed clinically for more than 50 years, is still a widely used anticoagulant. Unfortunately, some patients given this agent develop thrombocytopenia and thrombosis. Because this side effect can have catastrophic consequences, it is imperative that all clinicians caring for patients who receive heparin have at least a basic understanding of its pathogenesis, diagnosis, and management. Am. J. Hematol. 81:36-44, 2006Hematol. 81:36-44, . ª 2005 Wiley-Liss, Inc.

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“…The lack of a rapid test that is specific for the diagnosis of HIT is a limitation of current management strategies. The serotonin-release assay (SRA), a functional assay, has the highest specificity for clinically apparent HIT [10][11][12][13], but because of its complexity, it is available only in a few reference laboratories. Immunoassays such as the anti-platelet factor 4 (PF4)/heparin enzyme-immunoassay (EIA) are commonly used as a screening test for HIT because they have a high sensitivity (>99%) and are readily available.…”

Section: Introductionmentioning

confidence: 99%

Pitfalls in the diagnosis of heparin‐Induced thrombocytopenia: A 6‐year experience from a reference laboratory

et al. 2015

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Heparin-induced thrombocytopenia (HIT) is caused by platelet-activating antibodies against complexes of platelet factor 4 (PF4) and heparin. The diagnosis of HIT is contingent on accurate and timely laboratory testing. Recently, alternative anticoagulants for the treatment of HIT have been introduced along with algorithms for better HIT diagnosis. However, the increased reliance on immunoassays for the diagnosis of HIT may have harmful consequences due to the high rate of false positive results. To compare trends and implications of current HIT testing approaches, we analyzed results over a six-year period from the McMaster University Platelet Immunology Reference Laboratory. From 2008 to 2013, 8,546 samples were investigated for HIT using both an in-house IgG-specific anti-PF4/heparin enzyme immunoassay (EIA) and the serotoninrelease assay (SRA). Of 8,546 samples tested, 13.4% were true-positives (positive in both assays); 65.6% were true-negatives (negative in both assays); 20.9% were presumed false positive for HIT (EIA-positive/SRAnegative); and 0.2% were EIA-negative/SRA-positive. The frequency of EIA-positive/SRA-negative results increased over time (from 12.9% in 2008 to 22.9% in 2013). We found that the number of SRA-negative samples was reduced from referring centers that used an immunoassay as an initial screen; however, 41% of those samples tested negative in the immunoassay and in the SRA at the reference laboratory. The suspicion of HIT continues at a high rate and the agreement between the EIA and SRA test results remains problematic.

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Decision Analysis for Use of Platelet Aggregation Test, Carbon 14–Serotonin Release Assay, and Heparin–Platelet Factor 4 Enzyme-Linked Immunosorbent Assay for Diagnosis of Heparin-lnduced Thrombocytopenia

Abstract: A b s t r a c tHeparin-induced thrombocytopenia is a side effect of heparin therapy. In contrast to other drug-associated thrombocytopenias, however, the most frequently observed complication is not hemorrhage but thrombosis.

Cited by 177 publications

References 10 publications

Practical approach to the diagnosis and management of thrombocytopenia associated with tirofiban treatment

Practical approach to the diagnosis and management of thrombocytopenia associated with tirofiban treatment

Heparin‐induced thrombocytopenia and thrombosis

Pitfalls in the diagnosis of heparin‐Induced thrombocytopenia: A 6‐year experience from a reference laboratory

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