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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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B. Girolami, P. Prandoni, P. M. Stefani, C. Tanduo, P. Sabbion, P. Eichler, R. Ramon, G. Baggio, F. Fabris, and A. Girolami
The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study
Blood,
April 15, 2003;
101(8):
2955 - 2959.
[Abstract]
[Full Text]
[PDF]
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N. Lubenow, S. Selleng, H.-G. Wollert, P. Eichler, B. Mullejans, and A. Greinacher
Heparin-induced thrombocytopenia and cardiopulmonary bypass: perioperative argatroban use
Ann. Thorac. Surg.,
February 1, 2003;
75(2):
577 - 579.
[Abstract]
[Full Text]
[PDF]
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T. E. Warkentin
Pork or beef?
Ann. Thorac. Surg.,
January 1, 2003;
75(1):
15 - 16.
[Full Text]
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W. J DeBois, J. Liu, L. Y Lee, L. N Girardi, C. Mack, A. Tortolani, K. H Krieger, and O W. Isom
Diagnosis and treatment of heparin-induced thrombocytopenia
Perfusion,
January 1, 2003;
18(1):
47 - 53.
[Abstract]
[PDF]
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T. E. Warkentin
Invited commentary
Ann. Thorac. Surg.,
January 1, 2003;
75(1):
284 - 285.
[Full Text]
[PDF]
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T. E. Warkentin, W. C. Aird, and J. H. Rand
Platelet-Endothelial Interactions: Sepsis, HIT, and Antiphospholipid Syndrome
Hematology,
January 1, 2003;
2003(1):
497 - 519.
[Abstract]
[Full Text]
[PDF]
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B. M. Alving
How I treat heparin-induced thrombocytopenia and thrombosis
Blood,
January 1, 2003;
101(1):
31 - 37.
[Full Text]
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E. Lindhoff-Last, B. Wenning, M. Stein, F. Gerdsen, R. Bauersachs, and R. Wagnert
Risk Factors and Long-term Follow-up of Patients with the Immune Type of Heparin-Induced Thrombocytopenia
Clinical and Applied Thrombosis/Hemostasis,
October 1, 2002;
8(4):
347 - 352.
[Abstract]
[PDF]
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W. C. Aird and E. J. Mark
Case 15-2002 - A 53-Year-Old Man with a Myocardial Infarct and Thromboses after Coronary-Artery Bypass Grafting
N. Engl. J. Med.,
May 16, 2002;
346(20):
1562 - 1570.
[Full Text]
[PDF]
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Z. Q. Li, W. Liu, K. S. Park, B. S. Sachais, G. M. Arepally, D. B. Cines, and M. Poncz
Defining a second epitope for heparin-induced thrombocytopenia/thrombosis antibodies using KKO, a murine HIT-like monoclonal antibody
Blood,
February 15, 2002;
99(4):
1230 - 1236.
[Abstract]
[Full Text]
[PDF]
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T. E. Warkentin and J. G. Kelton
Delayed-Onset Heparin-Induced Thrombocytopenia and Thrombosis
Ann Intern Med,
October 2, 2001;
135(7):
502 - 506.
[Abstract]
[Full Text]
[PDF]
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E. Lindhoff-Last, C. Betz, and R. Bauersachs
Use of a Low-Molecular-Weight Heparinoid (Danaparoid Sodium) for Continuous Renal Replacement Therapy in Intensive Care Patients
Clinical and Applied Thrombosis/Hemostasis,
October 1, 2001;
7(4):
300 - 304.
[Abstract]
[PDF]
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G. M. Arepally and I. M. Mayer
Antibodies from patients with heparin-induced thrombocytopenia stimulate monocytic cells to express tissue factor and secrete interleukin-8
Blood,
August 15, 2001;
98(4):
1252 - 1254.
[Abstract]
[Full Text]
[PDF]
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J. Hirsh, S. S. Anand, J. L. Halperin, and V. Fuster
Guide to Anticoagulant Therapy: Heparin : A Statement for Healthcare Professionals From the American Heart Association
Arterioscler Thromb Vasc Biol,
July 1, 2001;
21
(7):
e9 - e9.
[Full Text]
[PDF]
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J. Hirsh, S. S. Anand, J. L. Halperin, and V. Fuster
Guide to Anticoagulant Therapy: Heparin : A Statement for Healthcare Professionals From the American Heart Association
Circulation,
June 19, 2001;
103(24):
2994 - 3018.
[Full Text]
[PDF]
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T. E. Warkentin and J. G. Kelton
Temporal Aspects of Heparin-Induced Thrombocytopenia
N. Engl. J. Med.,
April 26, 2001;
344(17):
1286 - 1292.
[Abstract]
[Full Text]
[PDF]
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K. R. McCrae, J. B. Bussel, P. M. Mannucci, G. Remuzzi, and D. B. Cines
Platelets: An Update on Diagnosis and Management of Thrombocytopenic Disorders
Hematology,
January 1, 2001;
2001(1):
282 - 305.
[Abstract]
[Full Text]
[PDF]
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J. A. Ginsberg, M. A. Crowther, R. H. White, and T. L. Ortel
Anticoagulation Therapy
Hematology,
January 1, 2001;
2001(1):
339 - 357.
[Abstract]
[Full Text]
[PDF]
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J. Hirsh, T. E. Warkentin, S. G. Shaughnessy, S. S. Anand, J. L. Halperin, R. Raschke, C. Granger, E. M. Ohman, and J. E. Dalen
Heparin and Low-Molecular-Weight Heparin Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and Safety
Chest,
January 1, 2001;
119
(2009):
64S - 94S.
[Full Text]
[PDF]
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