Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes

Autores: Martin Karlyn, Kia Leila, Parikh Neehar D, Kulik Laura, McMahon Brandon

Resumen

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 ranktesting. 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 Abpositive 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 withpositive 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.

Palabras clave: Survival thrombosis HIT transplantation.

2014-08-28   |   255 visitas   |   Evalua este artículo 0 valoraciones

Vol. 13 Núm.5. Septiembre-Octubre 2014 Pags. 548-554 Ann Hepatol 2014; 13(5)