2014, Number 5
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Ann Hepatol 2014; 13 (5)
Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes
Martin K, Kia L, Parikh ND, Kulik L, McMahon B
Language: English
References: 19
Page: 548-554
PDF size: 98.87 Kb.
ABSTRACT
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 χ
2 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.
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