Diagnosis and management of heparin-induced thrombocytopenia

Pouplard, Claire; Albaladéjo, Pierre; Bélisle, Sylvain; Blais, Normand; Bonhomme, Fanny; Borel‐Derlon, Annie; Borg, Jeanne‐Yvonne; Bosson, Jean Luc; Cohen, Ariel; Collet, Jean Philippe; Maistre, Emmanuel de; Faraoni, David; Fontana, Pierre; Huet, D. Garrigue; Godiér, Anne; Gruel, Yves; Guay, Jean‐Pierre; Hardy, Jean‐François; Huet, Y.; Ickx, Brigitte; Laporte, Silvy; Lasne, Dominique; Levy, Jerrold H.; Llau, J.V.; Gal, Grégoire Le; Lecompte, Thomas; Lessire, Sarah; Longrois, Dan; Madi-Jebara, Samia; Marret, Emmanuel; Mas, Julie; Mazighi, Mikaël; Meyer, Guy; Mismetti, Patrick; Morange, Pierre‐Emmanuel; Motte, Serge; Mullier, François; Nathan, Nathalie; Nguyên, Philippe; Ozier, Yves; Pernod, Gilles; Rosencher, Nadia; Roullet, Stéphanie; Roy, Pierre Marie; Samama, Charles‐Marc; Schlumberger, S.; Schved, J.F.; Sié, Pièrre; Steib, A.; Susen, Sophie; Testa, Sophie; Belle, Éric Van; Linden, Philipp; Vincentelli, André; Zufferey, P.

doi:10.1016/j.accpm.2020.03.012

Cited by 59 publications

(69 citation statements)

References 104 publications

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“…In the COVID-19 setting, it is reasonable to monitor the platelet count regularly between the 4th and the 14th day following the initiation of heparin therapy (once or twice a week in case of LMWH treatment, two to three times a week during UFH treatment), then once a week until the end of the first month of therapy. The development of thrombocytopenia (< 100 × 10 9 /L) or the rapid decrease in platelet count (especially if ≥50% in less than 24 h) should then suggest the diagnosis of HIT [166]. However, especially in the presence of acute inflammation and infection, other etiologies may explain a decrease in platelet count.…”

Section: Diagnosis Of Heparin-induced Thrombocytopenia (Hit)mentioning

confidence: 99%

“…This evaluation is generally performed with the 4Ts' score, much studied [167,168] [159], despite its limitations, particularly in more complex situations such as those encountered in ICU (no consensus on the drugs responsible for thrombocytopenia, many other causes of thrombocytopenia, very high negative predictive value but not absolute (e.g. thrombosis in the absence of thrombocytopenia), insufficient data on platelet count, weak agreement in the determination of the 4th criteria (other causes of thrombocytopenia)) [166,169,170].…”

Section: Diagnosis Of Heparin-induced Thrombocytopenia (Hit)mentioning

confidence: 99%

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Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

Hardy¹,

Lecompte

Douxfils

et al. 2020

Thrombosis J

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Coronavirus disease 2019 (COVID-19) is associated with extreme inflammatory response, disordered hemostasis and high thrombotic risk. A high incidence of thromboembolic events has been reported despite thromboprophylaxis, raising the question of a more effective anticoagulation. First-line hemostasis tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimers are proposed for assessing thrombotic risk and monitoring hemostasis, but are vulnerable to many drawbacks affecting their reliability and clinical relevance. Specialized hemostasis-related tests (soluble fibrin complexes, tests assessing fibrinolytic capacity, viscoelastic tests, thrombin generation) may have an interest to assess the thrombotic risk associated with COVID-19. Another challenge for the hemostasis laboratory is the monitoring of heparin treatment, especially unfractionated heparin in the setting of an extreme inflammatory response. This review aimed at evaluating the role of hemostasis tests in the management of COVID-19 and discussing their main limitations.

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Section: Diagnosis Of Heparin-induced Thrombocytopenia (Hit)mentioning

confidence: 99%

Section: Diagnosis Of Heparin-induced Thrombocytopenia (Hit)mentioning

confidence: 99%

Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

Hardy¹,

Lecompte

Douxfils

et al. 2020

Thrombosis J

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View full text Add to dashboard Cite

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“…However, SRA may not be sensitive enough to rule out the presence of pathogenic antibodies before cardiac surgery. Indeed, PF4-enhanced SRA has been described to be more sensitive than SRA, and since cardiac surgery induces a burst in PF4 plasma concentration, elevated intraoperative PF4 plasma concentrations might result in a positive SRA, mimicking thus in vivo a PF4-enhanced SRA [97]. HIT recurrence among patients with persisting anti-PF4/heparin antibodies who receive a single heparin dose is possible, especially if antibodies levels are high [98] and close medical and platelet follow-up is essential.…”

Section: Patients With Negative Functional Assay and Persisting Anti-mentioning

confidence: 99%

Heparin-Induced Thrombocytopenia: A Review of New Concepts in Pathogenesis, Diagnosis, and Management

Marchetti

Zermatten

Calderara

et al. 2021

JCM

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Knowledge on heparin-induced thrombocytopenia keeps increasing. Recent progress on diagnosis and management as well as several discoveries concerning its pathogenesis have been made. However, many aspects of heparin-induced thrombocytopenia remain partly unknown, and exact application of these new insights still need to be addressed. This article reviews the main new concepts in pathogenesis, diagnosis, and management of heparin-induced thrombocytopenia.

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“…Briefly, diagnosis of HIT involves several steps [11,117]. First of all, a clinical pre-test score (4Ts score) is frequently used to guide laboratory assays and allows for defining three levels of probability of HIT: low, intermediate and high, taking into account the severity of thrombocytopenia, the time to onset, the existence of thrombosis and other causes of thrombocytopenia.…”

Section: The Diagnosis Of Heparin-induced Thrombocytopenia Is Easier mentioning

confidence: 99%

“…Quinine was the first drug to be identified as causing immune-mediated thrombocytopenia over 100 years ago, but the incidence of DITP with this drug is rare, only of 26 cases per million patients treated [ 10 ]. Heparin-induced thrombocytopenia (HIT) is more frequent, affecting more than 1% of treated patients in certain clinical situations, and is distinguished from other DITP because it is associated in nearly half of all cases with thrombotic complications, and rarely with severe bleedings [ 11 , 12 ].…”

Section: Drugs and Mechanisms Involved In Drug-induced Immune Thromentioning

confidence: 99%

Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia

Vayne

Guéry

Rollin

et al. 2020

JCM

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Drug-induced immune thrombocytopenia (DITP) is a life-threatening clinical syndrome that is under-recognized and difficult to diagnose. Many drugs can cause immune-mediated thrombocytopenia, but the most commonly implicated are abciximab, carbamazepine, ceftriaxone, eptifibatide, heparin, ibuprofen, mirtazapine, oxaliplatin, penicillin, quinine, quinidine, rifampicin, suramin, tirofiban, trimethoprim-sulfamethoxazole, and vancomycin. Several different mechanisms have been identified in typical DITP, which is most commonly characterized by severe thrombocytopenia due to clearance and/or destruction of platelets sensitized by a drug-dependent antibody. Patients with typical DITP usually bleed when symptomatic, and biological confirmation of the diagnosis is often difficult because detection of drug-dependent antibodies (DDabs) in the patient’s serum or plasma is frequently not possible. This is in contrast to heparin-induced thrombocytopenia (HIT), which is a particular DITP caused in most cases by heparin-dependent antibodies specific for platelet factor 4, which can strongly activate platelets in vitro and in vivo, explaining why affected patients usually have thrombotic complications but do not bleed. In addition, laboratory tests are readily available to diagnose HIT, unlike the methods used to detect DDabs associated with other DITP that are mostly reserved for laboratories specialized in platelet immunology.

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Diagnosis and management of heparin-induced thrombocytopenia

Cited by 59 publications

References 104 publications

Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

Heparin-Induced Thrombocytopenia: A Review of New Concepts in Pathogenesis, Diagnosis, and Management

Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia

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