Evaluation of Serotonin Release Assay and Enzyme-Linked Immunosorbent Assay Optical Density Thresholds for Heparin-Induced Thrombocytopenia in Patients on Extracorporeal Membrane Oxygenation

Kataria, Vivek; Moore, Leanne; Harrison, Sarah; Hernandez, Omar; Vaughan, Nathan; Schwartz, Gary S.

doi:10.1097/ccm.0000000000004090

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…Unlike the ELISA, it is important to note that to date, studies which have formally validated or established a true semiquantitative correlation between LIA values and SRA positivity were not conducted specifically in a cardiothoracic surgical population, and instead used a heterogenous demographic. 12 , 15 , 16 The assumption that specificity will increase as LIA values rise beyond the currently established positivity threshold (≥ 1 unit/mL) without compromising sensitivity is unknown. Moreover, due to the increased risk of HIT in post-CTS patients, it is important to establish and evaluate the validity of LIA thresholds in this cohort.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Latex Immunoturbidimetric Assay Thresholds and HIT in Cardiothoracic Surgery

Hernandez

Patel

Biddlecome

et al. 2023

Clin Appl Thromb Hemost

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Background Heparin-induced thrombocytopenia (HIT) is a common differential diagnosis in cardiothoracic surgery. The latex immunoturbidimetric assay (LIA) is an enhanced immunoassay that has recently been introduced for the detection of total HIT immunoglobulin and retains a higher specificity of 95% compared to the enzyme-linked immunosorbent assay. Objectives To investigate if a semiquantitative relationship exists between increasing LIA levels beyond the current positivity threshold and its correlation to positive serotonin release assay results in cardiothoracic surgery. Methods This was a multicenter, observational cohort of cardiothoracic surgery patients initiated on anticoagulation with heparin-based products. To conduct sensitivity and specificity analysis of LIA values, HIT positive was defined as a LIA value ≥1 unit/mL and HIT negative was defined as a LIA level <1 unit/mL. A receiver operating characteristic (ROC) analysis was utilized to evaluate the predictive performance of the LIA. Results At manufactures’ cutoffs of ≥1.0 unit/mL, LIA sensitivity and specificity was 93.8% and 22%, respectively, yielding a false positive rate of 78%. At a higher cutoff of 4.5 units/mL, LIA sensitivity and specificity was 75% and 71%, respectively, yielding a false positive rate of 29% and an area under the ROC curve of 0.75 ( P = .01; 95% confidence interval: 0.621-0.889). Bivalirudin was initiated in 84.6% of false positive LIA results. Conclusion This study suggests that the diagnostic accuracy of the LIA can be optimized by increasing the LIA positivity threshold. Proposing a higher LIA cutoff, may mitigate unwarranted anticoagulation and bleeding outcomes.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Latex Immunoturbidimetric Assay Thresholds and HIT in Cardiothoracic Surgery

Hernandez

Patel

Biddlecome

et al. 2023

Clin Appl Thromb Hemost

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“…One complication of heparin therapy and heparin-coated circuits is HIT. Recently published data show that an OD threshold of 1.0 in anti-PF4/heparin antibody ELISA testing has a specificity of 89% and a negative predictive value of 95% for detecting/excluding HIT in ECMO patients on unfractionated heparin [ 12 ]. Therefore, our ELISA OD result of 2.63 together with the clinical features indicates a high likelihood of HIT.…”

Section: Discussionmentioning

confidence: 99%

Can Heparin-Coated ECMO Cannulas Induce Thrombocytopenia in COVID-19 Patients?

Steinlechner

Kargl

Schlömmer

et al. 2021

Case Reports in Immunology

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Extracorporeal membrane oxygenation (ECMO) is often used in the management of COVID-19-related severe respiratory failure. We report the first case of a patient with COVID-19-related ARDS on ECMO support who developed symptoms of heparin-induced thrombocytopenia (HIT) in the absence of heparin therapy. A low platelet count of 61 G/L was accompanied by the presence of circulating HIT antibodies 12 days after ECMO initiation. Replacement of the ECMO system including cannulas resulted in the normalization of the platelet count. However, the clinical situation did not improve, and the patient died 9 days later. Careful consideration of anticoagulant therapy and ECMO circuit, as well as routine HIT antibody testing, may prevent a fatal course in ECMO-supported COVID-19 patients.

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“…Most of these antibodies are non-pathogenic and do not affect the clinical course of patients. In that respect, increasing the value of the optical density threshold to 1.0 could enhance their specificity up to 89% [12]. HIT may have very heterogeneous clinical manifestations varying from asymptomatic forms to life-threatening thrombosis [13].…”

Section: Discussionmentioning

confidence: 99%

Heparin-induced thrombocytopenia in COVID-19 patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation: two case reports

et al. 2020

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Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is increasingly used in Coronavirus disease-19 patients with the most severe forms of acute respiratory distress syndrome (ARDS). Its use is associated with a significant hemostatic challenge, especially in COVID-19 patients who have been demonstrated to otherwise present a COVID-19-associated coagulopathy. The systematic use of unfractionated heparin therapy to prevent circuit thrombosis is warranted during ECMO support. The clinical presentation and management of heparin-induced thrombocytopenia, which is a rare but life-threatening complication of heparin therapy, has not been described in those patients yet. We report herein two cases of laboratory-confirmed HIT in COVID-19 patients with severe ARDS admitted to our intensive care unit for VV-ECMO support and the successful use of argatroban as an alternative therapy. We also provide a brief literature review of best evidence for managing such patients. The diagnosis and management of HIT is particularly challenging in COVID-19 patients receiving ECMO support. An increased awareness is warranted in those patients who already present a procoagulant state leading to higher rates of thrombotic events which can confuse the issues. Argatroban seems to be an appropriate and safe therapeutic option in COVID-19 patients with HIT while on VV-ECMO. Keywords COVID-19 • Extracorporeal membrane oxygenation • Heparin-induced thrombocytopenia • ArgatrobanPublisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Evaluation of Serotonin Release Assay and Enzyme-Linked Immunosorbent Assay Optical Density Thresholds for Heparin-Induced Thrombocytopenia in Patients on Extracorporeal Membrane Oxygenation

Cited by 5 publications

References 13 publications

Evaluation of Latex Immunoturbidimetric Assay Thresholds and HIT in Cardiothoracic Surgery

Evaluation of Latex Immunoturbidimetric Assay Thresholds and HIT in Cardiothoracic Surgery

Can Heparin-Coated ECMO Cannulas Induce Thrombocytopenia in COVID-19 Patients?

Heparin-induced thrombocytopenia in COVID-19 patients with severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation: two case reports

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