@article{126c50baf6b24dba8478ea842eb2ec45,
title = "Clinical outcomes in a cohort of patients with heparin-induced thrombocytopenia",
abstract = "Background: Heparin-induced thrombocytopenia (HIT) is a thrombotic disorder usually prompting treatment with non-heparin anticoagulants. The benefits and risks of such treatments have not been fully assessed. Methods: We analyzed data for 442 patients having a positive heparin-platelet factor 4 antibody test and recent heparin exposure. The primary outcome was a composite endpoint (death, limb amputation/gangrene, or new thrombosis). Secondary outcomes included bleeding and the effect of anticoagulation. Findings: Seventy-one patients (16%) had HIT with thrombosis (HIT-T); 284 (64%) had HIT without thrombosis (isolated HIT); 87 (20%) did not have HIT. An intermediate or high “4T” score was found in 85%, 58%, and 8% of the three respective groups. Non-heparin anticoagulation was begun in 80%, 56%, and 45%. The composite endpoint occurred in 48%, 36%, and 17% (P =.01) of which 61%, 38%, and 40% were receiving non-heparin anticoagulation. Compared with the no HIT group, the composite endpoint was significantly more likely in HIT-T [HR 2.48 (1.35-4.55), P =.003)] and marginally more likely in isolated HIT [HR 1.66 (0.96-2.85), P =.071]. Importantly, risk increased (HR 1.77, P =.02) after platelet transfusion. Major bleeding occurred in 48%, 36%, and 16% of the three groups (P =.005). Non-heparin anticoagulation was not associated with a reduction in composite endpoint events in either HIT group. Interpretation: HIT patients have high risks of death, limb amputation/gangrene, thrombosis, and bleeding. Non-heparin anticoagulant treatment may not benefit all patients and should be considered only after careful assessment of the relative risks of thrombosis and bleeding in individual patients.",
author = "Kuter, {David J.} and Konkle, {Barbara A.} and Hamza, {Taye H.} and Lynne Uhl and Assmann, {Susan F.} and Kiss, {Joseph E.} and Kaufman, {Richard M.} and Key, {Nigel S.} and Sachais, {Bruce S.} and Hess, {John R.} and Paul Ness and McCrae, {Keith R.} and Cindy Leissinger and Strauss, {Ronald G.} and McFarland, {Janice G.} and Ellis Neufeld and Bussel, {James B.} and Ortel, {Thomas L.}",
note = "Funding Information: We thank the many investigators and research coordinators in the Transfusion Medicine and Hemostasis Network who participated in this study. This work was funded by Grant Numbers HL072290, HL072033, HL072291, HL072196, HL072289, HL072191, HL072299, HL072305, HL072274, HL072028, HL072359, HL072072, HL072355, HL072346, HL072331, and HL072268 from the National Institutes of Health. The following investigators and staff participated in the study: University of Wisconsin, Madison: E. Williams (principal investigator), N. Turman; Froedert Memorial Lutheran Hospital, Milwaukee and St. Luke's Medical Center, Milwaukee: J. G. McFarland (principal investigator), D. Nischick; Cleveland Clinic, Cleveland: K.R. McCrae (principal investigator), Heesun Rogers, A. Smith, Y. Feng; Children's Hospital Boston, Boston: E.J. Neufeld (principal investigator), L. Lashley; Beth Israel Deaconess Medical Center, Boston: L. Uhl, E.R. Malynn; Brigham and Women's Hospital, Boston: S. Sloan, R.M. Kaufman, L. Magazu, S. Slate; Weill College of Cornell University, New York: J. Bussel (principal investigator), N. Haq; Duke University, Durham: T.L. Ortel (principal investigator), S. Adam, L. Talbott, M. Gleim, N. Mace, P. Jordan; Johns Hopkins University, Baltimore: P.M. Ness (principal investigator), R. Case, A. Fuller; Massachusetts General Hospital, Boston: D. Kuter (principal investigator), M. Sanchez-Hernandez; Puget Sound Blood Center and University of Washington Medical Center, Seattle: S.J. Slichter (principal investigator), T. Gernsheimer, L. Fitzpatrick; Tulane University Hospital and Clinics, New Orleans: C. Leissinger (principal investigator), R. Kruse-Jarres, C. Fournet, A. Kinzie; University of Iowa, Iowa City: R.G. Strauss (principal investigator), J. Swift, University of Maryland, Baltimore: J.R. Hess (principal investigator), A.B. Zimrin, A. Anazado, T. Gonzales, S. Sarracco; Fairview–University Medical Center, Minneapolis: J. McCullough (principal investigator), T. Carr, S. Pulkrabek; University of North Carolina, Chapel Hill: M.E. Brecher (principal investigator), A. Tsui, N. Key; University of Pennsylvania, Philadelphia: B. Sachais (principal investigator), M. Kelty; University of Pittsburgh, Pittsburgh: D.J. Triulzi (principal investigator), P. D'Andrea; New England Research Institutes (Data Coordinating Center), Watertown: S.F. Assmann (principal investigator), E. Devlin, E. Gerstenberger, J. Ghannam, T. Hamze, K. Hayes; National Heart, Lung, and Blood Institute, Bethesda: T. Mondoro (project officer), S. Glynn Publisher Copyright: {\textcopyright} 2017 Wiley Periodicals, Inc.",
year = "2017",
month = aug,
doi = "10.1002/ajh.24759",
language = "English (US)",
volume = "92",
pages = "730--738",
journal = "American journal of hematology",
issn = "0361-8609",
publisher = "Wiley-Liss Inc.",
number = "8",
}