Laboratory Evaluation of Heparin‐Induced Thrombocytopenia

Warkentin, Theodore E.; Moore, Jane C.

doi:10.1002/9781118543467.ch16

Cited by 9 publications

(31 citation statements)

References 68 publications

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“…The 4Ts score is defined as score 0-2 for each of the following criteria: thrombocytopenia with falling platelet counts more than 30% from baseline, onset time of falling platelets after the use of heparin, the occurrence of thrombosis and other causes of falling platelet counts unrelated to heparin (Table 1) [13,14].…”

Section: Introductionmentioning

confidence: 99%

Trombocitopenia em cirurgia cardíaca: importância diagnóstica e prognóstica

Rezende¹,

Morais²,

Silva³

et al. 2011

Rev Bras Cir Cardiovasc

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Section: Introductionmentioning

confidence: 99%

Trombocitopenia em cirurgia cardíaca: importância diagnóstica e prognóstica

Rezende¹,

Morais²,

Silva³

et al. 2011

Rev Bras Cir Cardiovasc

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“…Cessation of heparin and starting an alternative effective anticoagulant treatment is essentially required. The diagnosis of this clinicopathologic syndrome is based on compatible clinical picture and confirmed by in vitro demonstration of PF4/heparin antibodies using functional and immunological methods [1,2,8]. Although functional assays represent the gold standard in the definitive serological diagnosis of HIT, we could not perform since these assays are not readily available in our country.…”

Section: Discussionmentioning

confidence: 99%

“…Although functional assays represent the gold standard in the definitive serological diagnosis of HIT, we could not perform since these assays are not readily available in our country. Instead, we used clinical 4T scoring system and found high pre-test probability of HIT [8]. In most cases, although platelet count is low, this fall cannot be tied for any other reason.…”

Section: Discussionmentioning

confidence: 99%

Massive Pulmonary Embolism in a Patient with Heparin Induced Thrombocytopenia: Successful Treatment with Dabigatran

Bircan

Alanoğlu

2016

Eurasian J Med

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Heparin induced thrombocytopenia (HIT) is a rare, potentially fatal, immune-mediated complication of heparin therapy, associated with thrombosis and thrombocytopenia. In this study, a successful dabigatran administration in a case with massive pulmonary thromboembolism (mPTE) and HIT is presented. 57 years-old female, who was receiving low molecular weight heparin (LMWH) (0.4 mL once a daily, S.C. for 11 days) due to total knee replacement, was referred to our clinic with the hypotension and syncope attacks. Her echocardiography and pulmonary CT angiography findings were consistent with mPTE. We detected a serious decrease in her platelet count highly suggestive for HIT (plt: 54x10 3 /µL). LMWH was discontinued and dabigatran was started (150 mg twice daily). After platelet count increased over 150x10 3 /μL, dabigatran was switched to warfarin. Since heparin is widely used in medicine, all physicians need to be aware of this life threatening complication of heparin. Replacing heparin with an alternative anticoagulant such as dabigatran may become a life-saving strategy especially in case of HIT complicated with mPTE.Keywords: Dabigatran, heparin, low molecular weight heparin, new oral anticoagulants, pulmonary embolism. ÖzHeparin ilişkili trombositopeni (HIT), heparin tedavisinin nadir ancak ölümcül olabilen immun aracılı komplikasyonu olup, tromboz ve trombositopeni ile seyreder. Burada HIT ve masif pulmoner tromboemboli (mPTE) olgusunda başarılı Dabigatran (oral trombin inhibitörü) uygulaması sunulmaktadır. Total diz replasmani nedeniyle profilaktik düşük moleküler ağırlıklı heparin (DMAH, 0,4 mL 1x1, S.C., 11 gün) tedavisi altında olan 57 yaşında kadın hasta hipotansiyon ve senkop yakınmalarıyla kliniğimize sevk edildi. Ekokardiyografi ve pulmoner BT anjiyografi bulguları mPTE bulguları ile uyumlu idi. HIT tanısını düşündüren trombosit sayılarında belirgin düşme tespit edildi (plt: 54x10 3 /µL). Aldığı DMAH ve warfarin tedavisi hemen kesilerek Dabigatran başlandı (2x150 mg). Trombosit sayısı 150x10 3 /μL üzerine çıktıktan sonra dabigatran warfarin ile değiştirildi. Tüm hekimler tıpta yaygın olarak kullanılan heparinin hayatı tehdit eden bu komplikasyonunu akılda tutmalıdır. Heparinin dabigatran gibi alternatif bir antikoagulan ile değiştirilmesi mPTE ile komplike olmuş HIT olgularında hayat kurtaran bir strateji olabilir.Anahtar Kelimeler: Dabigatran, heparin, düşük moleküler ağır-lıklı heparin, yeni oral antikoagülanlar, pulmoner emboli.

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“…4,12,19 The present study also showed that HIT was diagnosed in 10.6% (11/104) of our patients with suspected HIT, whereas the reported prevalence of HIT in 13 studies selected for a recent meta-analysis to estimate the predictive value of the 4Ts scoring system in a heterogeneous group of patients with suspected HIT ranged from 4% to 42%. 20 The 4Ts score was first proposed by Warkentin and Heddle in 2003 21 and the first assessment of its diagnostic utility was reported by Lo et al in 2006. 9 In the latter study, the 4Ts score was used in two different centers (a Canadian general hospital and a German HIT testing laboratory) to assess patients with suspected HIT mainly derived from the patient categories of cardiovascular surgery, internal medicine, and intensive care.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the 4Ts scoring system and the antiplatelet factor 4/heparin antibodies test in critically ill patients

Matsumura

Nakada

Oda

2013

Acute Medicine & Surgery

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Aim: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction and potentially progresses to fatal thrombosis. The 4Ts scoring system has been reported as a clinical pretest for HIT. However, its usefulness in critically ill patients has not yet been thoroughly examined. Thus, we evaluated the clinical usefulness of the 4Ts score in the diagnosis of HIT in critically ill patients. Methods:One hundred and four critically ill patients who were admitted to our intensive care unit and who underwent the antiplatelet factor 4/heparin complex antibodies (PF4/heparin Ab) test with suspected HIT were enrolled in the study. The primary endpoint variable was the 4Ts score. The secondary endpoint variables were laboratory data, length of stay, and mortality, compared between thePF4/ heparin Ab positive and negative groups.Results: There was no significant difference in the 4Ts scores between the PF4/heparin Ab positive and negative groups. The positive predictive value (HIT patients/4T high score patients) was 15.4% (2/13), the negative predictive value (non-HIT patients/4T low score patients) was 87.5% (42/48), and the false-negative rate for the 4Ts score (4T low score patients/HIT patients) was as high as 54.5% (6/11). The PF4/heparin Ab positive patients had longer stay in intensive care compared to the PF4/heparin Ab negative patients (P = 0.035). Conclusions:The present study showed the discrepancy between the 4Ts score and PF4/heparin Ab. When HIT is suspected in critically ill patients, an immediate HIT antibody test and initiation of therapeutic management of HIT are required regardless of the 4Ts score.

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Laboratory Evaluation of Heparin‐Induced Thrombocytopenia

Cited by 9 publications

References 68 publications

Trombocitopenia em cirurgia cardíaca: importância diagnóstica e prognóstica

Trombocitopenia em cirurgia cardíaca: importância diagnóstica e prognóstica

Massive Pulmonary Embolism in a Patient with Heparin Induced Thrombocytopenia: Successful Treatment with Dabigatran

Relationship between the 4Ts scoring system and the antiplatelet factor 4/heparin antibodies test in critically ill patients

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