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Trends in Incidence and Diagnosis of Heparin-Induced Thrombocytopenia at a Tertiary Medical Center Implications for Patient Care



Trends in Incidence and Diagnosis of Heparin-Induced Thrombocytopenia at a Tertiary Medical Center Implications for Patient Care



Blood 100(11): Abstract No 3812, November 16



Background Recently, heparin-induced thrombocytopenia (HIT) has received increased attention. According to MEDLINE, 456 articles on HIT were published in the 19 years between 1969, when HIT was first described, to 1998. In contrast, some 476 articles have appeared within just the last 4 years. Whether this is due to increased prevalence of HIT with increased heparin use, or to increased awareness and testing is unclear. Methods We reviewed our diagnoses of HIT over the last 5 years, against the denominator of the number of laboratory tests for HIT requested and total hospital admissions. Results Table 1 shows admissions, HIT tests and HIT diagnoses at our institution for 1997-2001. These data indicate an increasing incidence of HIT, despite a constant number of coronary artery bypass surgeries; the main source of HIT cases at our institution. Using GLM analysis, we estimate that the incidence of HIT grew by 1.5% annually (p<0.06), although the number of assays performed increased more rapidly. Discussion Although this analysis does not necessarily indicate that the incidence of HIT is increasing nationwide, it has undoubtedly done so at our institution; at least partly due to increased awareness. Our laboratory uses an immunoassay for HIT antibodies and while its sensitivity is high, it may be less specific for clinical HIT. Although it is possible that resultant over-diagnosis exposes patients to alternative, more expensive, anticoagulants, the immunoassay may also correlate with outcome as was recently shown with regard to cardiac surgery, in which antibody presence alone corelated with a 215% increase in either death or length of stay over 10 days (Slaughter, T. et.al, SCA28, Anesth Analg.2002; 93). New anticoagulants may also provide superior anticoagulation over heparin in non-HIT patients and thereby reduce relative morbidity in this population. In 4312 patients studied undergoing angioplasty, for example, bivalirudin reduced ischemic and bleeding events by 22% and 62%, respectively, compared to heparin.(Bittl,J. et.al., AHJ 2001;142: 952-9) The number of HIT diagnoses may potentially be further increased by the ongoing development of rapid assays for heparin-platelet-factor-4 antibodies, or until susceptible patients are widely treated with alternative anticoagulants to heparin.

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