Heparin-Induced Thrombocytopenia in Iranian Cardiac Surgery Patients Using the 4Ts Clinical Scoring System and Laboratory Methods
Background: Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction. HIT diagnosis needs an algorithmic approach including clinical evaluation and laboratory tests (screening and confirmatory). Few studies have been conducted on HIT in Iran, and most existing research has been gene...
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| Format: | Article |
| Language: | English |
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Tehran University of Medical Sciences
2021-10-01
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| Series: | International Journal of Hematology-Oncology and Stem Cell Research |
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| Online Access: | https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1324 |
| _version_ | 1797724050103992320 |
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| author | Minoo Ahmadinejad Massoumeh Shahbazi Azita Chegini |
| author_facet | Minoo Ahmadinejad Massoumeh Shahbazi Azita Chegini |
| author_sort | Minoo Ahmadinejad |
| collection | DOAJ |
| description | Background: Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction. HIT diagnosis needs an algorithmic approach including clinical evaluation and laboratory tests (screening and confirmatory). Few studies have been conducted on HIT in Iran, and most existing research has been general and based on clinical evaluations alone. The present study was conducted to determine the prevalence of HIT among cardiac surgery patients using an algorithmic approach.
Materials and Methods: A cross-sectional study was carried out over a period of 10 months, at Modares Hospital (Tehran, Iran) on 92 patients who were candidates for cardiac surgery. For the clinical evaluation, the 4Ts scoring system was used; in cases with 4Ts scores ≥4, a laboratory evaluation of anti-PF4/heparin antibody (Ab) was performed by enzyme-linked immunosorbent assay (ELISA) and a HIPA test too as a functional confirmatory method. The patients with 4Ts scores ≥4 who were ELISA positive (OD ≥0.2) and HIPA positive were taken as a definite case of HIT.
Results: Of the 92 patients who had undergone cardiac surgery, 14 (15%) had 4Ts scores ≥4. Anti- PF4/heparin Ab was detected in eight patients using the ELISA and in six patients using the HIPA. Ultimately, definite HIT was confirmed in five of the patients.
Conclusion: The prevalence of HIT was 5.4% among the cardiac surgery patients assessed in the present study. To the researchers’ knowledge, this is the first time that HIT has been evaluated in Iran using a comprehensive algorithmic approach including clinical history-taking and both immunological and functional laboratory tests, and the findings showed a slightly higher HIT frequency in this single-center study in comparison with the other studies carried out in other countries. |
| first_indexed | 2024-03-12T10:11:41Z |
| format | Article |
| id | doaj.art-73564a046af1453d9287a12ca004ac5f |
| institution | Directory Open Access Journal |
| issn | 2008-2207 |
| language | English |
| last_indexed | 2024-03-12T10:11:41Z |
| publishDate | 2021-10-01 |
| publisher | Tehran University of Medical Sciences |
| record_format | Article |
| series | International Journal of Hematology-Oncology and Stem Cell Research |
| spelling | doaj.art-73564a046af1453d9287a12ca004ac5f2023-09-02T10:49:11ZengTehran University of Medical SciencesInternational Journal of Hematology-Oncology and Stem Cell Research2008-22072021-10-0115410.18502/ijhoscr.v15i4.7478Heparin-Induced Thrombocytopenia in Iranian Cardiac Surgery Patients Using the 4Ts Clinical Scoring System and Laboratory MethodsMinoo Ahmadinejad0Massoumeh Shahbazi1Azita Chegini2Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IranBlood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IranBlood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IranBackground: Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction. HIT diagnosis needs an algorithmic approach including clinical evaluation and laboratory tests (screening and confirmatory). Few studies have been conducted on HIT in Iran, and most existing research has been general and based on clinical evaluations alone. The present study was conducted to determine the prevalence of HIT among cardiac surgery patients using an algorithmic approach. Materials and Methods: A cross-sectional study was carried out over a period of 10 months, at Modares Hospital (Tehran, Iran) on 92 patients who were candidates for cardiac surgery. For the clinical evaluation, the 4Ts scoring system was used; in cases with 4Ts scores ≥4, a laboratory evaluation of anti-PF4/heparin antibody (Ab) was performed by enzyme-linked immunosorbent assay (ELISA) and a HIPA test too as a functional confirmatory method. The patients with 4Ts scores ≥4 who were ELISA positive (OD ≥0.2) and HIPA positive were taken as a definite case of HIT. Results: Of the 92 patients who had undergone cardiac surgery, 14 (15%) had 4Ts scores ≥4. Anti- PF4/heparin Ab was detected in eight patients using the ELISA and in six patients using the HIPA. Ultimately, definite HIT was confirmed in five of the patients. Conclusion: The prevalence of HIT was 5.4% among the cardiac surgery patients assessed in the present study. To the researchers’ knowledge, this is the first time that HIT has been evaluated in Iran using a comprehensive algorithmic approach including clinical history-taking and both immunological and functional laboratory tests, and the findings showed a slightly higher HIT frequency in this single-center study in comparison with the other studies carried out in other countries.https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1324Heparin; Heparin-induced thrombocytopenia (HIT), Diagnosis; Laboratory testing; Cardiac surgery |
| spellingShingle | Minoo Ahmadinejad Massoumeh Shahbazi Azita Chegini Heparin-Induced Thrombocytopenia in Iranian Cardiac Surgery Patients Using the 4Ts Clinical Scoring System and Laboratory Methods International Journal of Hematology-Oncology and Stem Cell Research Heparin; Heparin-induced thrombocytopenia (HIT), Diagnosis; Laboratory testing; Cardiac surgery |
| title | Heparin-Induced Thrombocytopenia in Iranian Cardiac Surgery Patients Using the 4Ts Clinical Scoring System and Laboratory Methods |
| title_full | Heparin-Induced Thrombocytopenia in Iranian Cardiac Surgery Patients Using the 4Ts Clinical Scoring System and Laboratory Methods |
| title_fullStr | Heparin-Induced Thrombocytopenia in Iranian Cardiac Surgery Patients Using the 4Ts Clinical Scoring System and Laboratory Methods |
| title_full_unstemmed | Heparin-Induced Thrombocytopenia in Iranian Cardiac Surgery Patients Using the 4Ts Clinical Scoring System and Laboratory Methods |
| title_short | Heparin-Induced Thrombocytopenia in Iranian Cardiac Surgery Patients Using the 4Ts Clinical Scoring System and Laboratory Methods |
| title_sort | heparin induced thrombocytopenia in iranian cardiac surgery patients using the 4ts clinical scoring system and laboratory methods |
| topic | Heparin; Heparin-induced thrombocytopenia (HIT), Diagnosis; Laboratory testing; Cardiac surgery |
| url | https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/1324 |
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