ArticleJournal of thrombosis and thrombolysis2015
Over-testing for heparin induced thrombocytopenia in hospitalized patients.
Article in Journal of thrombosis and thrombolysis, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 24 citations in OpenAlex.
- Electronic consultation to improve care outcomes in patients with suspected and confirmed heparin-induced thrombocytopenia.Research and practice in thrombosis and haemostasis · 2024Article
- An institutional report of heparin induced thrombocytopenia type II in aneurysmal subarachnoid hemorrhage patients.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2023Article
- Systems-based hematology: highlighting successes and next steps.Blood advances · 2020Review
- Prevalence and aetiology of moderate and severe thrombocytopenia in a tertiary and quaternary centre in KwaZulu-Natal.African journal of laboratory medicine · 2020Article
- Use of a whole-cell ELISA to detect additional antibodies in setting of suspected heparin-induced thrombocytopenia.European journal of haematology · 2019Article
- HITTING the Diagnosis: Testing for Heparin-Induced Thrombocytopenia in Cancer Patients.American journal of clinical pathology · 2018Article
- Platelet response to direct thrombin inhibitor or fondaparinux treatment in patients with suspected heparin-induced thrombocytopenia.Journal of thrombosis and thrombolysis · 2018Article
- Heparin-Induced Thrombocytopenia in Healthy Individuals with Continuous Heparin Infusion.TH open : companion journal to thrombosis and haemostasis · 2018Article
- False positive immunoassay for heparin-induced thrombocytopenia in the presence of monoclonal gammopathy: a case report.Biochemia medica · 2017Article
- Heparin induced thrombocytopenia with mechanical circulatory support devices: review of the literature and management considerations.Journal of thrombosis and thrombolysis · 2017Review
- A high-value cost conscious approach to minimize heparin induced thrombocytopenia antibody (HITAb) testing using the 4T score.Journal of thrombosis and thrombolysis · 2016Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Heparin induced thrombocytopenia (HIT) is a pro-thrombotic and potentially fatal complication of heparin therapy. Its diagnosis rests on high clinical probability and the laboratory demonstration of anti-PF4/heparin antibodies. The high prevalence of thrombocytopenia in hospitalized patients and the high sensitivity but low specificity of immunoassays for HIT antibodies can lead to over-testing and over-diagnosis. We conducted a study to review HIT screening practices in a tertiary care setting. We reviewed 63 consecutive patients undergoing testing for anti-PF4/heparin antibodies over 3 months. Pre-test probability for HIT was calculated using the 4T score. Sixty three patients underwent testing for anti-PF4/heparin antibodies. Twenty one had been admitted for cardiovascular surgery, 5 for other surgery and 35 for non-surgical indications. Twenty nine patients (46 %) had low pre- test probability, twenty three (36.5 %) had intermediate probability, and eleven (17.4 %) had high pre-test probability of having HIT. Anti-PF4/heparin ELISA was positive in 8 of 63 patients. SRA was ordered for 16 patients and was positive in 5. Only five patients were diagnosed and treated for HIT. Over-testing for HIT is highly prevalent in a tertiary care setting. This increases cost and exposes patients to expensive anti-coagulation with its attendant risk of hemorrhage. The 4Ts score has been shown to have high sensitivity and may be used to rule out HIT in most situations, although its utility depends on subjective analysis. Consistently applying this in practice could minimize over-testing and facilitate safer, cost-effective care.
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