Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes
Introduction. Heparin-induced thrombocytopenia (HIT) is a serious complication seen in hospitalized, medically-ill patients. Evaluation for HIT using a commercially-available ELISA-based test has become increasingly common; however, it does have a high false positive rate. Implications of HIT testin...
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| Format: | Article |
| Language: | English |
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Elsevier
2014-09-01
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| Series: | Annals of Hepatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268119312554 |
| _version_ | 1818741457374150656 |
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| author | Karlyn Martin Leila Kia Neehar D. Parikh Laura Kulik Brandon McMahon |
| author_facet | Karlyn Martin Leila Kia Neehar D. Parikh Laura Kulik Brandon McMahon |
| author_sort | Karlyn Martin |
| collection | DOAJ |
| description | Introduction. Heparin-induced thrombocytopenia (HIT) is a serious complication seen in hospitalized, medically-ill patients. Evaluation for HIT using a commercially-available ELISA-based test has become increasingly common; however, it does have a high false positive rate. Implications of HIT testing in patients with cirrhosis have not yet been reported.Material and methods. We conducted a single-institution, retrospective review of all patients with cirrhosis admitted over a 29-month period. The student’s t-test and the χ2 test were used for comparisons. We performed a stratified survival analysis using Kaplan-Meier and log rank testing.Results. A total of 1,305 patients had a HIT Ab sent during the study period. Of these patients, 106 had cirrhosis and were included in the study. Eighteen (17%) of the patients with cirrhosis were HIT Ab positive and four of the eighteen had a positive Serotonin Release Assay (SRA) confirmatory test. No difference was found in platelet nadir, thrombotic rate, length of stay, and patient survival between patients with positive HIT Ab and negative HIT Ab testing. No consistent treatment was used among patients who were HIT Ab positive, despite hematology service consultation. Patients who were HIT Ab negative were more likely to have undergone liver transplantation compared to those who were positive (27 vs. 5.5%, respectively; p = 0.048).Conclusion. Our data suggest that HIT Ab testing is over-used in patients with cirrhosis and is poorly predictive of outcomes. With a poor positive predictive value, HIT testing may add unnecessary complexity to an already complicated patient population. |
| first_indexed | 2024-12-18T01:56:56Z |
| format | Article |
| id | doaj.art-7582c5b813514e82b3998d06e1f3bd24 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-18T01:56:56Z |
| publishDate | 2014-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-7582c5b813514e82b3998d06e1f3bd242022-12-21T21:24:54ZengElsevierAnnals of Hepatology1665-26812014-09-01135548554Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomesKarlyn Martin0Leila Kia1Neehar D. Parikh2Laura Kulik3Brandon McMahon4Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. U.S.ADepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. U.S.ADivision of Gastroenterology, Department of Medicine, University of Michigan Health System, Ann Arbor, MI. U.S.A; Correspondence and reprint request:Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago IL. U.S.ADivision of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago. IL. U.S.AIntroduction. Heparin-induced thrombocytopenia (HIT) is a serious complication seen in hospitalized, medically-ill patients. Evaluation for HIT using a commercially-available ELISA-based test has become increasingly common; however, it does have a high false positive rate. Implications of HIT testing in patients with cirrhosis have not yet been reported.Material and methods. We conducted a single-institution, retrospective review of all patients with cirrhosis admitted over a 29-month period. The student’s t-test and the χ2 test were used for comparisons. We performed a stratified survival analysis using Kaplan-Meier and log rank testing.Results. A total of 1,305 patients had a HIT Ab sent during the study period. Of these patients, 106 had cirrhosis and were included in the study. Eighteen (17%) of the patients with cirrhosis were HIT Ab positive and four of the eighteen had a positive Serotonin Release Assay (SRA) confirmatory test. No difference was found in platelet nadir, thrombotic rate, length of stay, and patient survival between patients with positive HIT Ab and negative HIT Ab testing. No consistent treatment was used among patients who were HIT Ab positive, despite hematology service consultation. Patients who were HIT Ab negative were more likely to have undergone liver transplantation compared to those who were positive (27 vs. 5.5%, respectively; p = 0.048).Conclusion. Our data suggest that HIT Ab testing is over-used in patients with cirrhosis and is poorly predictive of outcomes. With a poor positive predictive value, HIT testing may add unnecessary complexity to an already complicated patient population.http://www.sciencedirect.com/science/article/pii/S1665268119312554SurvivalThrombosisHITTransplantation |
| spellingShingle | Karlyn Martin Leila Kia Neehar D. Parikh Laura Kulik Brandon McMahon Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes Annals of Hepatology Survival Thrombosis HIT Transplantation |
| title | Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes |
| title_full | Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes |
| title_fullStr | Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes |
| title_full_unstemmed | Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes |
| title_short | Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes |
| title_sort | heparin induced thrombocytopenia testing is over utilized in cirrhosis amp correlates with poor clinical outcomes |
| topic | Survival Thrombosis HIT Transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S1665268119312554 |
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