Clinical and Biologic Features of Patients Suspected or Confirmed to Have Heparin-Induced Thrombocytopenia in a Cardiothoracic Surgical ICU

Trehel-Tursis, Virginie; Louvain-Quintard, Virginie; Zarrouki, Youssef; Imbert, Audrey; Doubine, Sylvie; Stéphan, François

doi:10.1378/chest.11-3074

Cited by 42 publications

(31 citation statements)

References 46 publications

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“…The present study showed that the incidence of HIT in critically ill Japanese patients was 0.22% (11/5,095), a value within the range 0-0.47% reported in European and North American ICUs. 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.…”

Section: Discussionsupporting

confidence: 55%

“…In line with previous reports that the etiology of thrombocytopenia is multifactorial, 1,2 there were still many patients for whom we could not fully explain their etiologies. However, the reported prevalence of HIT is extremely low, less than 0.2-5% in patients receiving heparin 16,27,28 and less than 0.5% in ICU patients, 4,12,19,29 and it should be noted that the negative predictive value of a diagnostic test is higher when the prevalence of the target disease in the population to be tested is lower. 30 The positive predictive value of the 4Ts score was as low as 15.4%, a value less than the previously reported range from 21.4% to 100%.…”

Section: Discussionmentioning

confidence: 99%

“…5 In addition to serological diagnosis by an HIT antibody test, a pretest clinical scoring system involving evaluation of the following four scores (4Ts score) has been reported as a clinical pretest for HIT (Table 1): 8,9 (i) thrombocytopenia, (ii) timing of platelet count fall, (iii) thrombosis or other sequelae, (iv) other cause for thrombocytopenia. Validation of the clinical usefulness of the 4Ts score has been reported for cardiac surgery patients [10][11][12] and hemodialysis patients. 13,14 Although the 4Ts score has an advantage in that it eliminates HIT without carrying out an HIT antibody test due to its high negative predictive values, 7 some patients are reported to develop HIT even with a low 4Ts score.…”

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confidence: 99%

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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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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…The frequency of accumulation in our study is similar to rates reported by others [17,18]. The incidence of clinically suspected HIT (6/73 patients (8%) in the heparin group) was similar to numbers reported by Hetzel et al ., yet higher than numbers reported by others [23,24]. When HIT was suspected, the diagnosis was not routinely confirmed by antibody testing, so that the incidence may have been overestimated.…”

Section: Discussionmentioning

confidence: 86%

Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial

et al. 2014

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IntroductionBecause of ongoing controversy, renal and vital outcomes are compared between systemically administered unfractionated heparin and regional anticoagulation with citrate-buffered replacement solution in predilution mode, during continuous venovenous hemofiltration (CVVH) in critically ill patients with acute kidney injury (AKI).MethodsIn this multi-center randomized controlled trial, patients admitted to the intensive care unit requiring CVVH and meeting inclusion criteria, were randomly assigned to citrate or heparin. Primary endpoints were mortality and renal outcome in intention-to-treat analysis. Secondary endpoints were safety and efficacy. Safety was defined as absence of any adverse event necessitating discontinuation of the assigned anticoagulant. For efficacy, among other parameters, survival times of the first hemofilter were studied.ResultsOf the 139 patients enrolled, 66 were randomized to citrate and 73 to heparin. Mortality rates at 28 and 90 days did not differ between groups: 22/66 (33%) of citrate-treated patients died versus 25/72 (35%) of heparin-treated patients at 28 days, and 27/65 (42%) of citrate-treated patients died versus 29/69 (42%) of heparin-treated patients at 90 days (P = 1.00 for both). Renal outcome, i.e. independency of renal replacement therapy 28 days after initiation of CVVH in surviving patients, did not differ between groups: 29/43 (67%) in the citrate-treated patients versus 33/47 (70%) in heparin-treated patients (P = 0.82). Heparin was discontinued in 24/73 (33%) of patients whereas citrate was discontinued in 5/66 (8%) of patients (P < 0.001). Filter survival times were superior for citrate (median 46 versus 32 hours, P = 0.02), as were the number of filters used (P = 0.002) and the off time within 72 hours (P = 0.002). The costs during the first 72 hours of prescribed CVVH were lower in citrate-based CVVH.ConclusionsRenal outcome and patient mortality were similar for citrate and heparin anticoagulation during CVVH in the critically ill patient with AKI. However, citrate was superior in terms of safety, efficacy and costs.Trial registrationClinicaltrials.gov NCT00209378. Registered 13th September 2005.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0472-6) contains supplementary material, which is available to authorized users.

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“…However, the incidence of HIT is low in ICU patients. In a large prospective study comprising 5.949 ICU patients (2.751 after cardiac surgery and 3.198 after thoracic surgery), HIT was clinically suspected in 1.7% at a median of 5 (range, 4-9) days after ICU admission [33]. Most of the studies investigating thrombocytopenia and ICU mortality exclude HIT patients using the presence of clinical criteria suggestive of HIT and the presence of platelet factor-4 antibodies [34,35].…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia: A Risk Factor of Mortality for Patients with Sepsis in the Intensive Care Unit

Burunsuzoglu¹,

Saltürk²,

Karakurt³

et al. 2016

Turk Toraks Dergisi

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OBJECTIVES:The objective of this study was to evaluate the intensive care unit (ICU) and long-term mortality in sepsis patients with/ without thrombocytopenia on the fifth day of ICU admission. MATERIALS AND METHODS:The retrospective observational cohort study was performed in a teaching hospital, and patients with sepsis who stayed more than 4 days in the ICU between January 2012 and December 2012 were included. Patients were divided into two groups according to thier platelet count at fifth day of ICU stay: Group 1, < 150.000/μL; Group 2, >150.000/μL. Patients having thrombocytopenia on admission were excluded. The patients' characteristics, comorbid diseases, body mass index, arterial blood gas analysis and blood biochemistry results, SIRS criteria, Acute Physiological and Chronic Health Evaluation Score II (APACHE II), implication of invasive and non-invasive mechanical ventilation, use of sedation, nutrition information, and culture results of microbiological samples were recorded. The groups were compared according to the recorded data. Logistic regression analysis was performed for ICU mortality; the Kaplan-Meier test was used to evaluate 12-month survival after ICU discharge. RESULTS:During the period, 1003 patients were admitted to the ICU; 307 sepsis patients were included in the study. Group 1 (n= 67) and Group 2 (n=240) had similar patient characteristics and sepsis findings. The groups had similar ICU and hospital stays; mortality was higher in Group 1 than in Group 2 (40.3% vs. 17.5%, respectively, p< 0.001). Fifth day thrombocytopenia, septic shock, male gender, and low albumin levels were found to be risk factors of ICU mortality; the respective odds ratios, 95% confidence intervals, and p values for these factors were 3.03, [1.15-7.45 CONCLUSION:Higher rates of septic shock and mortality were seen in sepsis patients with thrombocytopenia in the ICU. The measurement of thrombocytopenia in the ICU, which is easy and low-cost, may help to predict mortality. Thus, precautions can be taken early in patient treatment and follow-up. As we know, early intervention is crucial in the approach to sepsis.

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Clinical and Biologic Features of Patients Suspected or Confirmed to Have Heparin-Induced Thrombocytopenia in a Cardiothoracic Surgical ICU

Cited by 42 publications

References 46 publications

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

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

Citrate anticoagulation versus systemic heparinisation in continuous venovenous hemofiltration in critically ill patients with acute kidney injury: a multi-center randomized clinical trial

Thrombocytopenia: A Risk Factor of Mortality for Patients with Sepsis in the Intensive Care Unit

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