The risk of major bleeding in patients with suspected heparin‐induced thrombocytopenia

Abstract

Background The presence of a hypercoagulable disorder such as heparin‐induced thrombocytopenia (HIT) may protect against anticoagulant‐associated bleeding. Objectives To determine the incidence of major bleeding in patients with suspected HIT. Methods We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT−) and exposure to an alternative anticoagulant (Tx+ or Tx−). Secondary outcomes included the incidence of new/progressive thrombosis and 30‐day mortality. Results The incidence of major bleeding was high in the HIT+Tx+, HIT− Tx+, and HIT−Tx− groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P = .24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44‐3.47), platelet count < 25 × 109/L (HR 2.13, 1.10‐4.12), and renal dysfunction (HR 1.56, 1.06‐2.27); 35.7% of HIT+Tx+, 13.8% HIT−Tx+, and 9.3% of HIT−Tx− patients experienced new or progressive thrombosis. Mortality was similar among the three groups (26.2% HIT+Tx+, 34.5% HIT−Tx+, and 26.7% of HIT−Tx− [P = .34]). Conclusions Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.

Heparin-induced thrombocytopenia (HIT): Review of incidence, diagnosis, and management

“… Hallmark and less common clinical presentations of HIT are described. 49,51–61 CVC, central venous catheter; DIC, disseminated intravascular coagulation; DVT, deep vein thrombosis; HIT, heparin-induced thrombocytopenia; PE, pulmonary embolism; VKA, vitamin K antagonist. …”

Severe Thrombocytopenia in a Patient with Submassive Pulmonary Embolism and Heparin-Induced Thrombocytopenia: to Lyse or Not to Lyse?

“…In our experience of 461 patients treated for suspected, confirmed, or previous history of HIT, major bleeding rate was 7.6% with bivalirudin [14]. In a recently published retrospective analysis by Pishko et al, the incidence of major bleeding in patients with HIT treated with non-heparin anticoagulant was even higher at 40.9% (13). The hemorrhagic complications from thrombolysis have been reported as high as 19% [15].…”

“…Thrombosis associated with HIT has a mortality rate as high as 20-30% [12]. The treatment of HIT with alternative anticoagulant does carry an increased risk of bleeding, although it is commonly assumed that HIT protects against anticoagulation-associated bleeding despite profound thrombocytopenia [13].…”

The treatment of integrated traditional Chinese and Western medicine to cure severe immune thrombocytopenia in a patient in a minimally conscious state: a case report

“…Yang observed 34 patients hospitalized with pulmonary infection and reported that the proportion of patients who progressed to moderate and severe thrombocytopenia was about 47% and 30% respectively (7). When the platelet count is less than 100×10 9 /L, it is defined as Thrombocytopenia, mild, moderate, severe and extremely severe thrombocytopenia are judged according to the platelet count of 50×10 9 /L to 100×10 9 /L, 30×10 9 /L to 50×10 9 /L, 10×10 9 /L to 30×10 9/ L, less than 10×10 9 /L respectively (8). Mild to moderate thrombocytopenia has no obvious symptoms or signs; however, severe and extremely severe thrombocytopenia carries a high risk of visceral hemorrhage and intracranial hemorrhage (9).…”