Clinical and Biologic Features of Patients Suspected or Confirmed to Have Heparin-Induced Thrombocytopenia in a Cardiothoracic Surgical ICU

• Published in: Chest Vol. 142; no. 4; pp. 837 - 844
• Main Authors: Trehel-Tursis, Virginie, MD, Louvain-Quintard, Virginie, MD, PhD, Zarrouki, Youssef, MD, Imbert, Audrey, MD, Doubine, Sylvie, MD, Stéphan, François, MD, PhD
• Format: Journal Article
• Language: English
• Published: Northbrook, IL American College of Chest Physicians 01-10-2012
• Subjects: Aged; Antibodies - blood; Anticoagulants - adverse effects; Anticoagulants - immunology; Biological and medical sciences; Biomarkers - blood; Cardiac Surgical Procedures; Cardiology. Vascular system; Female; Follow-Up Studies; France - epidemiology; Hematologic and hematopoietic diseases; Heparin - adverse effects; Heparin - immunology; Humans; Incidence; Intensive Care Units; Male; Medical sciences; Middle Aged; Platelet Count; Platelet diseases and coagulopathies; Pneumology; Prospective Studies; Pulmonary/Respiratory; Thoracic Surgical Procedures; Thrombocytopenia - chemically induced; Thrombocytopenia - diagnosis; Thrombocytopenia - epidemiology; Thrombosis - prevention & control; France; Human; Thrombocytopenia; Patient; Hemopathy; Anticoagulant; Intensive care unit; Symptomatology; Platelet; Treatment; Surgery; Glycosaminoglycan; Anesthesia; Circulatory system; Heparin; Cardiology
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.11-3074

Background The diagnosis of heparin-induced thrombocytopenia (HIT) is problematic in the surgical ICU, as there are multiple potential explanations for thrombocytopenia. We conducted a study to assess the incidence, clinical presentation, and outcome of HIT in a cardiothoracic surgical ICU. Methods From January 2005 to December 2010, all patients with suspicion of HIT were prospectively identified, and data were collected retrospectively. Detection of anti-PF4/heparin antibodies and functional assays were systematically performed. Results During the study period, 5,949 patients were admitted to the ICU (2,751 after cardiac surgery and 3,198 after thoracic surgery), of whom 101 were suspected to have HIT (1.7% [95% CI, 1.4%-2.0%]). Suspicion of HIT occurred at a median of 5 (4-9) days after ICU admission. Diagnosis was confirmed in 28 of 5,949 patients (0.47% [95% CI, 0.33%-0.68%]). Thrombosis was detected in 14 patients with HIT (50%) and in 12 patients without HIT (16%) ( P = .0006). After receiver operating characteristic analysis (area under curve = 0.78 ± 0.06), a 4Ts score ≥ 5 had a sensitivity of 86% and a specificity of 70%. Course of platelet count was similar between the two groups. Six patients (21%) with HIT and 20 (27%) without died ( P = .77). Conclusions Even with a prospective platelet monitoring protocol, suspicion for HIT arose in < 2% of patients in a cardiothoracic ICU. Most were found to have other causes of thrombocytopenia, with HIT confirmed in 28 of 101 suspected cases (0.47% of all patients in the ICU). The 4Ts score may have value by identifying patients who should have laboratory testing performed. The mortality of patients with HIT was not different from other very ill thrombocytopenic patients in the ICU.