Disease burden, complication rates, and health-care costs of heparin-induced thrombocytopenia in the USA: a population-based study

Abstract

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Incidence and outcomes of heparin‐induced thrombocytopenia in solid malignancy: an analysis of the National Inpatient Sample Database

“…Our study estimates the incidence of HIT in hospitalized patients with solid malignancy to be 0·08% corresponding approximately to 1 in 1250 hospitalizations. This is marginally higher than the incidence of 0·06% (1 in 1500) in the all‐cause hospitalizations (Dhakal et al , ). Due to the nature of the NIS sampling and data collection technique, causation cannot be established but a possible explanation for the higher incidence of HIT associated with solid malignancy can be increased heparin exposure due to increased risk of thromboembolism (Sallah et al , ) and maintenance of patency of vascular access devices.…”

“…All hospitalizations associated with a secondary diagnosis of HIT were identified using the ICD‐9 CM code 289·84. The diagnostic sensitivity and specificity of the HIT ICD‐9 CM codes have been well established in previously published articles; 90·9% (95% CI, 57·1–99·5) and 94·4% (95% CI, 91·1–96·6) respectively (Dhakal et al , ). We decided to exclude hospitalizations with a primary diagnosis of HIT ( n = 140) because it is almost exclusively an inpatient diagnosis.…”

“…The NIS database serves as an ideal source of data for this study because HIT is an inpatient diagnosis and its large sample size enables analyses of rare diseases. The disease burden of HIT should be well captured by the NIS given the high specificity and sensitivity of the ICD‐9 code for HIT reported by Dhakal et al ().…”

“…Heparin‐induced thrombocytopenia (HIT) is an immune‐mediated adverse reaction to heparin products characterized by thrombocytopenia with or without thrombosis. In a recently published article, the incidence of HIT was found to be 0·065% in general hospitalized patients (Dhakal et al , ). Other studies with smaller sample sizes have reported HIT in 0·2–3% (Martel et al , ).…”

“…HIT results from the autoantibody formed against platelet factor‐4 (PF‐4) and heparin complex. Increased risk of HIT is reported in surgical patients (especially cardiovascular or orthopaedic) and with exposure to unfractionated heparin products compared to medical patients and low molecular weight heparin (LMWH) respectively (Martel et al , ; Warkentin et al , ; Chaudhry et al , ; Aguayo et al , ; Dhakal et al , ). Due to the rarity of this condition, there is a paucity of data regarding its incidence and outcomes in patients with a solid malignancy (Miriovsky & Ortel, ).…”