Screening frequency, incidence and pattern of heparin-induced thrombocytopenia syndrome at a large tertiary institution

Mya, Hae Tha; Tay, Hui Ming; Gan, Shien Wen Sheryl; Surendran, Shilpa; Yeang, Shu Hui; Lim, Cynthia Ciwei; Choong, Hui Lin; Lee, Lai Heng; Ng, Heng Joo

doi:10.1007/s12185-016-2013-3

Cited by 8 publications

(3 citation statements)

References 29 publications

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“…One Japanese study [19] found a mild decrease in heparin-induced thrombocytopenia (HIT) incidence with LMWH which was 0.6% (0% in patients without central venous catheter, 2.3% in patients with central venous catheter), compared to previous reports with UFH which were 3.9% and 1.0%, respectively [20] and [21]. In the existing study, the group of patients with blood platelets of less than 150,000 /mm3 showed statistically significant improvement in platelet number with shifting to enoxaparin.…”

Section: Discussionmentioning

confidence: 93%

Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Megahed

Tawfik

Hles

et al. 2021

AJMAH

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Background: Maintaining the patency of the extracorporeal circuit (ECC) is required. The cost and long-term effect of anticoagulants on hemodialysis (HD) patients' parameters are still matters of concern. We aimed to study the effect of shifting to enoxaparin instead of unfractionated heparin (UFH) during HD and evaluate its efficacy, safety, and benefits. Design and methodology: This study was conducted at Arar hospital, Kingdom of Saudi Arabia (KSA), and included 86 end-stage renal disease (ESRD) patients on HD for six months starting from October 2017. All patients had been on UFH as an anticoagulant during hemodialysis sessions before they were shifted to equivalent doses of enoxaparin sodium (Clexan®) as a therapeutic upgrade to start with. The patients’ files were examined retrospectively for the period of UFH therapy and then all patients were observed prospectively for at least 6 months while on Clexane. The occurrence of clotting in the dialysis sets were recorded and the need for urgent HD for each patient and the reasons. Results: There was a reduction of filter clots even with the reduction of enoxaparin dose. There was a significant reduction of mean cholesterol, calcium, phosphorus, sodium, chloride, and serum osmolality. We found a significant reduction of pre-dialysis potassium among those who presented with a pre-dialysis potassium of higher than 5.5 mg/dl during the enoxaparin phase. Patients, who had thrombocytopenia while on UFH; showed improvement in platelet count after the shift to enoxaparin. However, patients who had platelet count lowered than 150000/mm3 6 months after having been shifted to enoxaparin; many of them received HD through a permanent catheter. No patients had a three-fold increase of normal values (3ULN) of liver function tests whether being on heparin or enoxaparin. Conclusion: Low molecular weight heparin (LMWH) could be more efficacious and safe than UFH with the improvement of some variables in HD patients.

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Section: Discussionmentioning

confidence: 93%

Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Megahed

Tawfik

Hles

et al. 2021

AJMAH

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“…Over the last two decades, a wide range of HIA prevalence in HD has been reported in studies using EIA, ranging from 0 to 47% [ 22 – 37 , 39 ]. The finding that HIA levels inversely correlate with time on HD helps explain the wide variance as these studies did not standardize time on HD.…”

Section: Discussionmentioning

confidence: 99%

Temporality of heparin-induced antibodies: a retrospective study in outpatients undergoing hemodialysis on unfractionated heparin

et al. 2018

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BackgroundHeparin-induced antibodies (HIA) are responsible for causing heparin-induced thrombocytopenia and thrombosis. Research has shown that the temporality of heparin-induced antibodies does not follow the classic immunologic response. The immunobiology of HIA generation remains unclear with varying in vitro and in vivo data. Outpatients undergoing hemodialysis (HD) are exposed to heparin chronically. The HIA immune response can therefore be investigated in vivo in this population.MethodsWe examined the time between the start of HD using unfractionated heparin and HIA levels in 212 outpatients during a 6-year period. Antibodies were detected on enzyme-linked immunosorbent assay. HIA levels were analyzed to determine significance of the trend over time. HIA subgroups were also analyzed for correlation with subsequent thrombotic events and platelet count during follow up.ResultsOverall, the HIA response in HD was found to peak early with waning antibody response despite continued exposure to heparin. The peak prevalence of a strong immune response (optical density > 1.000) was early and short lived, while weaker immune response (optical density 0.400–1.000) persisted for the first 6 months then declined. The mean follow-up time per patient was 2.3 ± 1.4 years. Despite circulating HIA, including high titers, no patients developed HIT in this sample. There was no association between HIA and thrombocytopenia. There was increased incidence of thrombosis in patients with strong HIA compared to other groups, but this did not achieve statistical significance.ConclusionsThe data suggest a significant temporal pattern of HIA in outpatients undergoing HD using unfractionated heparin. Positive HIA was not found to be significantly associated with thrombocytopenia or thrombosis risk in these patients. However, while not achieving statistical significance, subsequent thrombotic events occurred most frequently in the strong positive HIA group (optical density > 1.000). Further research into HIA and risk of thrombosis in this population is needed.

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“…It usually challenging in hospitalized patients as majority of the patients will have other causes of thrombocytopenia and also not all physicians are applying the 4Ts score for the pretest probability as recent studies have shown. [5][6][7] The primary objective of this study is to evaluate the frequency of HIT among Sultan Qaboos University Hospital (SQUH) patients and the secondary objective is to assess the utility of the 4T scoring system (which is validated clinical tool that predicts the likelihood of HIT).…”

Section: Introductionmentioning

confidence: 99%

Clinical presentation and evaluation of the utility of the 4t scoring system in the diagnosis of heparin induced thrombocytopenia among patients at sultan qaboos university hospital

AL-Mamari¹,

Al-Farsi²

2018

HTIJ

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Objectives: Heparin induced thrombocytopenia (HIT), albeit uncommon, is a potentially fatal complication heparin therapy. Early diagnosis and prompt intervention has been shown to prevent catastrophic thrombotic complications seen in patients with this condition. The aim of this study is to evaluate the frequency of HIT among Sultan Qaboos University Hospital (SQUH) patients and assess the utility of the 4T scoring system (which is validated clinical tool that predicts the likelihood of HIT). Methods: This is a retrospective cohort study. All patients who were suspected to have HIT and had a HIT assay (by ELISA) between June 2006 and December 2014 were identified from the LabTrack system. Data were collected on their clinical presentation, outcome and the variables included in the 4T scores (i.e. degree of thrombocytopenia, timing of thrombocytopenia, evidence of thrombosis and absence of other causes of thrombocytopenia) were collected using the electronic patient records. The total 4T scores were calculated. Sensitivity, specificity and negative and positive predictive values were calculated. Results: Out of 129 consecutive patients, 64 were males and 65 were females. Mean age was 57years. 9% had thrombosis (% venous, % arterial and % both). 0(and 0%) had a low 4T score (score 0-3), 3(2%) had intermediate (score 4-5) and 6(4.6%) had high scores (score 6-8). 9(7%) of all patients were positive (HIT ELISA optic Density >1.0 unit) and 120(92%) were negative. A positive result was seen in 0 (0%) of the low risk group, 3(2%) of the intermediate risk group and 9(7%) of the high risk group. Conclusion: The study illustrates the validity of the 4Ts scoring system in our patient population with high negative predictive value, in agreement with the published literature. In addition, it illustrates the over use of resources and highlights the need to improve the awareness among clinician about this validated predictive tool to avoid over investigation or over treatment

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Screening frequency, incidence and pattern of heparin-induced thrombocytopenia syndrome at a large tertiary institution

Cited by 8 publications

References 29 publications

Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Effects of Changing Anticoagulation with Unfractionated Heparin into Enoxaparin in Hemodialysis Patients:Prospective Non Randomized Unicentre Study

Temporality of heparin-induced antibodies: a retrospective study in outpatients undergoing hemodialysis on unfractionated heparin

Clinical presentation and evaluation of the utility of the 4t scoring system in the diagnosis of heparin induced thrombocytopenia among patients at sultan qaboos university hospital

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