The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia.
anticoagulants/adverse event
anticoagulants/therapeutic use
heparin/adverse event
thrombocytopenia
thrombosis
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
22
04
2019
accepted:
22
07
2019
pubmed:
28
7
2019
medline:
1
9
2020
entrez:
28
7
2019
Statut:
ppublish
Résumé
The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding. To determine the incidence of major bleeding in patients with suspected HIT. We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT-) and exposure to an alternative anticoagulant (Tx+ or Tx-). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality. The incidence of major bleeding was high in the HIT+Tx+, HIT- Tx+, and HIT-Tx- groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P = .24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44-3.47), platelet count < 25 × 10 Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.
Sections du résumé
BACKGROUND
The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding.
OBJECTIVES
To determine the incidence of major bleeding in patients with suspected HIT.
METHODS
We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT-) and exposure to an alternative anticoagulant (Tx+ or Tx-). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality.
RESULTS
The incidence of major bleeding was high in the HIT+Tx+, HIT- Tx+, and HIT-Tx- groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P = .24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44-3.47), platelet count < 25 × 10
CONCLUSIONS
Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.
Identifiants
pubmed: 31350937
doi: 10.1111/jth.14587
pmc: PMC6913895
mid: NIHMS1043808
pii: S1538-7836(22)02707-6
doi:
Substances chimiques
Anticoagulants
0
Heparin
9005-49-6
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1956-1965Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL142122
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL007971
Pays : United States
Informations de copyright
© 2019 International Society on Thrombosis and Haemostasis.
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