Does negative heparin-platelet factor 4 enzyme-linked immunosorbent assay effectively exclude heparin-induced thrombocytopenia?

Fohlen-Walter, A.; Maistre, Emmanuel de; Mulot, A.; Marchand-Arvier, M.; Lecompte, Thomas

doi:10.1046/j.1538-7836.2003.00282.x

Cited by 20 publications

(10 citation statements)

References 18 publications

(28 reference statements)

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“…We confirm the excellent negative predictive value of immunologic assay (all patients with HIT had anti‐H‐PF4 antibodies) but also its lack of specificity (26.5% of patients free of HIT had anti‐H‐PF4 antibodies) [2–4]. Cases of HIT without anti‐H‐PF4 antibodies exists but to our knowledge, have not been reported after CPB [22]. A simple test based on the ID‐microtyping particle agglutination system has been described for rapid detection of anti‐H‐PF4 antibodies [23].…”

Section: Discussionsupporting

confidence: 69%

Diagnostic score for heparin‐induced thrombocytopenia after cardiopulmonary bypass

Louët

Boutouyrie

Alhenc‐Gelas

et al. 2004

Journal of Thrombosis and Haemostasis

157

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To cite this article: Lillo-Le Louë t A, Boutouyrie P, Alhenc-Gelas M, Le Beller C, Gautier I, Aiach M, Lasne D. Diagnostic score for heparin-induced thrombocytopenia after cardiopulmonary bypass. J Thromb Haemost 2004; 2: 1882-8.See also Matthai Jr WH, Cines DB. Towards a diagnosis of heparin-induced thrombocytopenia after cardiopulmonary bypass. This issue, pp 1879-81.Summary. Heparin-induced thrombocytopenia (HIT) occurs in nearly 3% of patients treated with heparin after cardiopulmonary bypass (CPB). HIT carries a risk of severe thrombotic complications, and must be diagnosed rapidly. To identify simple criteria for estimating the probability of HIT after CPB, we retrospectively analyzed the files of 84 patients with suspected HIT after CPB and we analyzed the usefulness of several variables collected at the time of HIT suspicion to estimate HIT probability. HIT was confirmed in 35 cases and ruled out in 49 cases, on the basis of a platelet increment after heparin withdrawal, detection of heparin-dependent antibodies, and absence of other clear cause of thrombocytopenia. A biphasic platelet count from CPB to the first day of suspected HIT, an interval of ‡ 5 days from CPB to the first day of suspected HIT, and a CPB duration of £ 118 min were independent risk factors for HIT. These variables were combined to create a post-CPB HIT probability score. The score correctly identified 34/35 HIT patients and 28/49-non-HIT patients. This score, which can be applied as soon as HIT is suspected after CPB, has very good negative predictive value (97%). Prospective studies are required to confirm these findings.

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Section: Discussionsupporting

confidence: 69%

Diagnostic score for heparin‐induced thrombocytopenia after cardiopulmonary bypass

Louët

Boutouyrie

Alhenc‐Gelas

et al. 2004

Journal of Thrombosis and Haemostasis

157

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“…Detailed characteristics of all 128 diagnostic accuracy studies are given in supplemental PaGIA (14), 20,36,42,45,46,53,58,64,65,68,70,72,75,79 PIFA (1), 28 lateral flow immunoassay (9), [54][55][56]58,66,70,72 latex agglutination assay (1), 37 and CLIA (24). 37,38,57,61,62,77 Available assays, antibody specificities, thresholds, test variations, and manufacturers are illustrated in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Several authors have raised concerns that the diagnostic value may differ relevantly among the individual tests. 2,[22][23][24] As a result of this uncertainty, the application of assays varies greatly among laboratories. 25 The aim of the present investigation was to assess the diagnostic accuracy with regard to different classes of assays, antibody specificities, thresholds, manufacturers, application of a high-dose heparin confirmation step, and material used.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of immunoassays for heparin-induced thrombocytopenia: a systematic review and meta-analysis

Nagler

Bachmann

Cate

et al. 2016

Blood

120

126

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“…ELISA can also be positive in the presence of nonpathogenic antibodies in patients who do not have clinical HIT, so it is highly sensitive (90%-95%), with an excellent negative-predictive value for HIT. 34 Thus, the detection of the antiheparin-PF4 antibodies by ELISA does not confirm HIT, but a negative ELISA result makes HIT highly unlikely. Recently developed assay kits are now available to improve selectivity for pathogenic antibodies by only detecting IgG antibodies, which are more likely pathogenic, unlike the IgA and IgM antibodies, which are nonpathogenic.…”

Section: Laboratory Assays For Hitmentioning

confidence: 99%

“…However, if the clinical suspicion is high for HIT and the initial ELISA is negative, repeating the test in 48 to 72 hours is indicated. 60 In addition, the strength of a positive test result correlates with the diagnosis and provides useful diagnostic information regarding the likelihood of clinically relevant HIT. 61 As proposed by ACCP guidelines, 58 there is no evidence that routine testing for anti-PF4 antibody before cardiac or vascular surgery in a patient without thrombocytopenia or other clinical evidence of HIT leads to improved outcomes.…”

Section: Prevention Of Hit-associated Complicationsmentioning

confidence: 99%

The identification and management of heparin-induced thrombocytopenia in the vascular patient

LaMuraglia

Houbballah

Laposata

2012

Journal of Vascular Surgery

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Heparin-induced thrombocytopenia (HIT) is a serious, acquired, prothrombotic disorder caused by an antibody response to the heparin-platelet factor 4 complex, which can precipitate arterial as well as venous thromboembolic complications. HIT should be suspected in patients exposed to heparin who present with an unexplained thrombosis or a significant drop in platelet count, or both. Once HIT is suspected or identified, there are specific approaches to its diagnosis and management, with emphasis on removal of all heparin compounds and administration of alternative nonheparin anticoagulants. Generally, HIT is a self-limiting syndrome that resolves when the antibody titers disappear. Patients should be anticoagulated for up to 6 months, depending on the clinical scenario; however, the management of patients with remote or recent HIT requiring a vascular procedure requires special considerations.

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Does negative heparin-platelet factor 4 enzyme-linked immunosorbent assay effectively exclude heparin-induced thrombocytopenia?

Cited by 20 publications

References 18 publications

Diagnostic score for heparin‐induced thrombocytopenia after cardiopulmonary bypass

Diagnostic score for heparin‐induced thrombocytopenia after cardiopulmonary bypass

Diagnostic value of immunoassays for heparin-induced thrombocytopenia: a systematic review and meta-analysis

The identification and management of heparin-induced thrombocytopenia in the vascular patient

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