Low ADAMTS‐13 predicts adverse outcomes in hospitalized patients with suspected heparin‐induced thrombocytopenia
Abstract Background Heparin‐induced thrombocytopenia (HIT) is a life‐threatening thrombotic complication after heparin exposure. However, the role of ADAMTS‐13 and von Willebrand factor (VWF) in the disease process and outcomes of HIT is not known. Objective To determine the potential role of ADAMTS...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-08-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
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| Online Access: | https://doi.org/10.1002/rth2.12581 |
| _version_ | 1797713957718327296 |
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| author | Meng Chan Xinyang Zhao X. Long Zheng |
| author_facet | Meng Chan Xinyang Zhao X. Long Zheng |
| author_sort | Meng Chan |
| collection | DOAJ |
| description | Abstract Background Heparin‐induced thrombocytopenia (HIT) is a life‐threatening thrombotic complication after heparin exposure. However, the role of ADAMTS‐13 and von Willebrand factor (VWF) in the disease process and outcomes of HIT is not known. Objective To determine the potential role of ADAMTS‐13 and VWF in hospitalized patients suspected with HIT. Methods Associations of the HIT tests, ADAMTS‐13 activity, and VWF antigen or activity with other clinical parameters and outcomes in the patients suspected with HIT were determined. Results Of 261 patients, 87 (33.3%) were positive and 174 (66.7%) were negative for a HIT antibody determined by an enzyme immunoassay (EIA). Of these 87 EIA+ patients, 31 (35.6%) were also positive but 56 (64.4%) were negative for serotonin‐releasing assay (SRA). There was no statistically significant difference among all three groups (i.e., EIA–, EIA+/SRA+, and EIA+/SRA–) as to their demographic features, reasons for admission to the hospital, type of procedures performed, and in‐hospital mortality. Compared to those in the healthy controls, plasma ADAMTS‐13 activity in patients suspected with HIT was significantly lower but plasma VWF antigen (VWFAg) and activity (VWFAc) in these patients were significantly higher. While there was no statistically significant difference among all three groups regarding plasma levels of ADAMTS‐13 activity, VWFAg, and VWFAc, plasma levels of ADAMTS‐13 activity <50% or the low ratios of ADAMTS‐13 activity to VWFAg (or VWFAc) are highly predictive for a 90‐day mortality rate, particularly in the EIA+SRA+ group. Conclusions These results demonstrate that relative deficiency of plasma ADAMTS‐13 activity in hospitalized patients suspected with HIT is common, which may contribute at least in part to the adverse outcomes in this patient population, particularly in those with true HIT. |
| first_indexed | 2024-03-12T07:44:58Z |
| format | Article |
| id | doaj.art-685fc3bcc5ec4a9a9eb401275c5d9e15 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T07:44:58Z |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-685fc3bcc5ec4a9a9eb401275c5d9e152023-09-02T21:03:38ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792021-08-0156n/an/a10.1002/rth2.12581Low ADAMTS‐13 predicts adverse outcomes in hospitalized patients with suspected heparin‐induced thrombocytopeniaMeng Chan0Xinyang Zhao1X. Long Zheng2Departments of Pathology and Laboratory Medicine The University of Kansas Medical Center Kansas City KSUSADepartments of Biochemistry and Molecular Genetics The University of Alabama at Birmingham Birmingham AL USADepartments of Pathology and Laboratory Medicine The University of Kansas Medical Center Kansas City KSUSAAbstract Background Heparin‐induced thrombocytopenia (HIT) is a life‐threatening thrombotic complication after heparin exposure. However, the role of ADAMTS‐13 and von Willebrand factor (VWF) in the disease process and outcomes of HIT is not known. Objective To determine the potential role of ADAMTS‐13 and VWF in hospitalized patients suspected with HIT. Methods Associations of the HIT tests, ADAMTS‐13 activity, and VWF antigen or activity with other clinical parameters and outcomes in the patients suspected with HIT were determined. Results Of 261 patients, 87 (33.3%) were positive and 174 (66.7%) were negative for a HIT antibody determined by an enzyme immunoassay (EIA). Of these 87 EIA+ patients, 31 (35.6%) were also positive but 56 (64.4%) were negative for serotonin‐releasing assay (SRA). There was no statistically significant difference among all three groups (i.e., EIA–, EIA+/SRA+, and EIA+/SRA–) as to their demographic features, reasons for admission to the hospital, type of procedures performed, and in‐hospital mortality. Compared to those in the healthy controls, plasma ADAMTS‐13 activity in patients suspected with HIT was significantly lower but plasma VWF antigen (VWFAg) and activity (VWFAc) in these patients were significantly higher. While there was no statistically significant difference among all three groups regarding plasma levels of ADAMTS‐13 activity, VWFAg, and VWFAc, plasma levels of ADAMTS‐13 activity <50% or the low ratios of ADAMTS‐13 activity to VWFAg (or VWFAc) are highly predictive for a 90‐day mortality rate, particularly in the EIA+SRA+ group. Conclusions These results demonstrate that relative deficiency of plasma ADAMTS‐13 activity in hospitalized patients suspected with HIT is common, which may contribute at least in part to the adverse outcomes in this patient population, particularly in those with true HIT.https://doi.org/10.1002/rth2.12581ADATMS‐13heparin‐induced thrombocytopeniamortalitythromboembolismvon Willebrand factor |
| spellingShingle | Meng Chan Xinyang Zhao X. Long Zheng Low ADAMTS‐13 predicts adverse outcomes in hospitalized patients with suspected heparin‐induced thrombocytopenia Research and Practice in Thrombosis and Haemostasis ADATMS‐13 heparin‐induced thrombocytopenia mortality thromboembolism von Willebrand factor |
| title | Low ADAMTS‐13 predicts adverse outcomes in hospitalized patients with suspected heparin‐induced thrombocytopenia |
| title_full | Low ADAMTS‐13 predicts adverse outcomes in hospitalized patients with suspected heparin‐induced thrombocytopenia |
| title_fullStr | Low ADAMTS‐13 predicts adverse outcomes in hospitalized patients with suspected heparin‐induced thrombocytopenia |
| title_full_unstemmed | Low ADAMTS‐13 predicts adverse outcomes in hospitalized patients with suspected heparin‐induced thrombocytopenia |
| title_short | Low ADAMTS‐13 predicts adverse outcomes in hospitalized patients with suspected heparin‐induced thrombocytopenia |
| title_sort | low adamts 13 predicts adverse outcomes in hospitalized patients with suspected heparin induced thrombocytopenia |
| topic | ADATMS‐13 heparin‐induced thrombocytopenia mortality thromboembolism von Willebrand factor |
| url | https://doi.org/10.1002/rth2.12581 |
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