ArticleBlood2020
Rapid and accurate Bayesian diagnosis of heparin-induced thrombocytopenia.
Article in Blood, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Challenge of Detecting Heparin-induced Thrombocytopenia (HIT) in a Developing Country: A Systematic Review.Cardiovascular & hematological agents in medicinal chemistry · 2025Pooled it
- A combination of 2 rapid immunoassays significantly improves diagnostic sensitivity for heparin-induced thrombocytopenia.American journal of clinical pathology · 2026Observational
- Evaluation of an IgG anti-PF4/H chemiluminescent immunoassay in the diagnosis of heparin-induced thrombocytopenia.Blood vessels, thrombosis & hemostasis · 2025Article
- Article
- Proteomic profiling for biomarker discovery in heparin-induced thrombocytopenia.Blood advances · 2024Article
- Anti-PF4 ELISA-Negative, SRA-Positive Heparin-Induced Thrombocytopenia.Hematology reports · 2024Article
- A Functional Assay for the Determination of Heparin-Induced Thrombocytopenia via Flow Cytometry.Diagnostics (Basel, Switzerland) · 2023Article
- A machine-learning model for reducing misdiagnosis in heparin-induced thrombocytopenia: A prospective, multicenter, observational study.EClinicalMedicine · 2023Article
- Combinations of rapid immunoassays for a speedy diagnosis of heparin-induced thrombocytopenia.Journal of thrombosis and haemostasis : JTH · 2022Article
- Managing argatroban in heparin-induced thrombocytopenia: A retrospective analysis of 729 treatment days in 32 patients with confirmed heparin-induced thrombocytopenia.British journal of haematology · 2022Article
- Measurement of procoagulant platelets provides mechanistic insight and diagnostic potential in heparin-induced thrombocytopenia.Journal of thrombosis and haemostasis : JTH · 2022Article
- Platelet factor 4 polyanion immune complexes: heparin induced thrombocytopenia and vaccine-induced immune thrombotic thrombocytopenia.Thrombosis journal · 2021Review
- Heparin-Induced Thrombocytopenia: A Review of New Concepts in Pathogenesis, Diagnosis, and Management.Journal of clinical medicine · 2021Review
- Challenges in Detecting Clinically Relevant Heparin-Induced Thrombocytopenia Antibodies.Hamostaseologie · 2020Review
- Pathogenesis of heparin-induced thrombocytopenia.Translational research : the journal of laboratory and clinical medicine · 2020Review
- Combination of two complementary automated rapid assays for diagnosis of heparin-induced thrombocytopenia (HIT).Journal of thrombosis and haemostasis : JTH · 2020Article
- Detection of Platelet-Activating Antibodies Associated with Heparin-Induced Thrombocytopenia.Journal of clinical medicine · 2020Review
- Diagnosing HIT: the need for speed.Blood · 2020Article
- Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory.Thrombosis journal · 2020Review
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10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Prompt diagnostic evaluation of suspected heparin-induced thrombocytopenia (HIT) is critical for guiding initial patient management. We assessed the performance of 3 immunoassays detecting anti-platelet factor 4 (PF4)/heparin antibodies, derived a diagnostic algorithm with a short analytical turnaround time (TAT), and prospectively validated the algorithm. Plasma samples were analyzed by Zymutest-HIA-IgG, HemosIL-AcuStar-HIT-IgG, and ID-H/PF4-PaGIA in retrospective (n = 221) and prospective (n = 305) derivation cohorts. We calculated likelihood ratios of result intervals and cutoff values with 100% negative (NPV) and positive (PPV) predictive values for a positive gold standard functional assay (heparin-induced platelet activation [HIPA]). A diagnostic algorithm was established based on the Bayesian combination of pretest probability and likelihood ratios of first- and second-line immunoassays. Cutoffs with 100% PPV for positive HIPA were >3.0 U/mL (HemosIL-AcuStar-HIT-IgG) and titer ≥16 (ID-H/PF4-PaGIA); cutoffs with 100% NPV were <0.13 U/mL and ≤1, respectively. During the prospective validation of the derived algorithm (n = 687), HemosIL-AcuStar-HIT-IgG was used as unique testing in 566 (82.4%) of 687 cases (analytical TAT, 30 minutes). In 121 (17.6%) of 687 unresolved cases, ID-H/PF4-PaGIA was used as second-line testing (additional TAT, 30 minutes). The algorithm accurately predicted HIT in 51 (7.4%) of 687 patients and excluded it in 604 (87.9%) of 687 patients, leaving only 20 (2.9%) cases unresolved. We also identified 12 (1.7%) of 687 positive predictions not confirmed by HIPA: 10 patients with probable HIT despite negative HIPA and 2 possible false-positive algorithm predictions. The combination of pretest probability with first- and second-line immunoassays for anti-PF4/heparin antibodies is accurate for ruling in or out HIT in ≥95% of cases within 60 minutes. This diagnostic approach improves initial management of patients with suspected HIT.
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