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Blood, 1 September 2000, Vol. 96, No. 5, pp. 1703-1708
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Impact of the patient population on the risk for heparin-induced
thrombocytopenia
Theodore E. Warkentin,
Jo-Ann I. Sheppard,
Peter Horsewood,
Patricia J. Simpson,
Jane C. Moore, and
John G. Kelton
From the Department of Pathology and Molecular Medicine
and the Department of Medicine, McMaster University; and from the
Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences
Corporation, Hamilton, Ontario, Canada.
The frequency of immune heparin-induced thrombocytopenia
(HIT) varies among prospective studies. It is unknown whether this is
caused by differences in the heparin preparations, the patient populations, or the types of serologic assay used to confirm the diagnosis. Seven hundred forty-four patients were studied from 3 different clinical treatment settings, as follows: unfractionated heparin (UFH) during or after cardiac surgery (n = 100), UFH after orthopedic surgery (n = 205), and low-molecular-weight heparin (LMWH)
after orthopedic surgery (n = 439). Both an activation assay and an
antigen assay were used to detect heparin-dependent IgG (HIT-IgG)
antibodies. By activation assay, the frequency of HIT-IgG formation
ranged from a low of 3.2% in orthopedic patients receiving LMWH to a
high of 20% in cardiac patients receiving UFH; by antigen assay, the
corresponding frequencies ranged from 7.5% to 50%. Both UFH use
(P = .002) and cardiac surgery (P = .01)
were more likely to be associated with HIT-IgG formation. However,
among patients in whom HIT-IgG formed and who were administered UFH,
the probability for HIT was higher among orthopedic patients than among
cardiac patients (by activation assay: 52.6% compared with 5%; odds
ratio, 21.1 [95% CI, 2.2-962.8]; P = .001; by antigen assay: 34.5% compared with 2.0%; odds ratio, 25.8 [95% CI,
3.2-1141]; P < .001). It is concluded that there is an
unexpected dissociation between the frequency of HIT-IgG formation and
the risk for HIT that is dependent on the patient population. HIT-IgG
antibodies are more likely to form in patients who undergo cardiac
surgery than in orthopedic patients, but among patients in whom
antibodies do form, orthopedic patients are more likely to develop HIT.
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106(2):
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|
|
|
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168(1):
94 - 102.
[Abstract]
[Full Text]
[PDF]
|
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|
|
|
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[Abstract]
[PDF]
|
|
|
|
|
|
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December 15, 2007;
110(13):
4253 - 4260.
[Abstract]
[Full Text]
[PDF]
|
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|
|
|
|
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132(4):
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[Full Text]
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|
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|
|
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September 1, 2007;
105(3):
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|
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|
|
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September 1, 2007;
83(983):
575 - 582.
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[Full Text]
[PDF]
|
|
|
|
|
|
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134(1):
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|
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|
|
|
|
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131(6):
1620 - 1622.
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|
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|
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|
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131(6):
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|
|
|
|
|
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|
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|
|
|
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83(2):
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|
|
|
|
|
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83(1):
21 - 23.
[Full Text]
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|
|
|
|
|
|
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|
|
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|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
|
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809 - 817.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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J. Thorac. Cardiovasc. Surg.,
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131(6):
1373 - 1381.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. E. Lewis, D. E. Wallis, M. J. Hursting, R. L. Levine, and F. Leya
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June 1, 2006;
129(6):
1407 - 1416.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. de Maistre, Y. Gruel, and D. Lasne
Diagnosis and management of heparin-induced thrombocytopenia: [Le diagnostic et le traitement de la thrombopenie induite par l'heparine].
Can J Anesth,
June 1, 2006;
53(6_suppl):
S123 - S134.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. L. Levine, M. J. Hursting, and D. McCollum
Argatroban Therapy in Heparin-Induced Thrombocytopenia With Hepatic Dysfunction
Chest,
May 1, 2006;
129(5):
1167 - 1175.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Bennett-Guerrero, T. F. Slaughter, W. D. White, I. J. Welsby, C. S. Greenberg, H. El-Moalem, and T. L. Ortel
Preoperative anti-PF4/heparin antibody level predicts adverse outcome after cardiac surgery
J. Thorac. Cardiovasc. Surg.,
December 1, 2005;
130(6):
1567 - 1572.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Prandoni, S. Siragusa, B. Girolami, F. Fabris, and for the BELZONI Investigators Group
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Blood,
November 1, 2005;
106(9):
3049 - 3054.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Martel, J. Lee, and P. S. Wells
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October 15, 2005;
106(8):
2710 - 2715.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. R. Hetzel and C. Sucker
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Nephrol. Dial. Transplant.,
October 1, 2005;
20(10):
2036 - 2042.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. V Reddy, E. J Grossman, S. A Trevino, M. J Hursting, and P. T Murray
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October 1, 2005;
39(10):
1601 - 1605.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Suvarna, L. Rauova, E. K. E. McCracken, C. M. Goss, B. S. Sachais, S. E. McKenzie, M. P. Reilly, M. D. Gunn, D. B. Cines, M. Poncz, et al.
PF4/heparin complexes are T cell-dependent antigens
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August 1, 2005;
106(3):
929 - 931.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Hursting, B. E. Lewis, and D. E. Macfarlane
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July 1, 2005;
11(3):
279 - 287.
[Abstract]
[PDF]
|
|
|
|
|
|
|
I.-K. Jang and M. J. Hursting
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Circulation,
May 24, 2005;
111(20):
2671 - 2683.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. L. Levine
Finding Haystacks Full of Needles: From Opus to Osler
Chest,
May 1, 2005;
127(5):
1488 - 1490.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Pohl, A. Kredteck, B. Bastians, P. Hanfland, T. Klockgether, and U. Harbrecht
Heparin-induced thrombocytopenia in neurologic patients treated with low-molecular-weight heparin
Neurology,
April 12, 2005;
64(7):
1285 - 1287.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. G. Kelton
The Pathophysiology of Heparin-Induced Thrombocytopenia: Biological Basis for Treatment
Chest,
February 1, 2005;
127(2_suppl):
9S - 20S.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. E. Warkentin
New Approaches to the Diagnosis of Heparin-Induced Thrombocytopenia
Chest,
February 1, 2005;
127(2_suppl):
35S - 45S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. H. Matthai Jr
Thrombocytopenia in Cardiovascular Patients: Diagnosis and Management
Chest,
February 1, 2005;
127(2_suppl):
46S - 52S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. T. Gurbuz, W. G. Elliott, and A. A. Zia
Heparin-induced thrombocytopenia in the cardiovascular patient: diagnostic and treatment guidelines
Eur. J. Cardiothorac. Surg.,
January 1, 2005;
27(1):
138 - 149.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Savi, B. H. Chong, A. Greinacher, Y. Gruel, J. G. Kelton, T. E. Warkentin, P. Eichler, D. Meuleman, M. Petitou, J.-P. Herault, et al.
Effect of fondaparinux on platelet activation in the presence of heparin-dependent antibodies: a blinded comparative multicenter study with unfractionated heparin
Blood,
January 1, 2005;
105(1):
139 - 144.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Rice
Heparin-Induced Thrombocytopenia: Myths and Misconceptions (That Will Cause Trouble for You and Your Patient)
Arch Intern Med,
October 11, 2004;
164(18):
1961 - 1964.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Smythe, W. E. Dager, and N. M. Patel
Managing Complications of Anticoagulant Therapy
Journal of Pharmacy Practice,
October 1, 2004;
17(5):
327 - 346.
[Abstract]
[PDF]
|
|
|
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