Consequences of suspected heparin-induced thrombocytopenia in the ICU
© Ostermann et al.; licensee BioMed Central Ltd. 2012
Published: 20 March 2012
Clinical suspicion of heparin-induced thrombocytopenia (HIT) may prompt changes in drug management and alert clinicians to an increased risk of thrombosis. However, thrombocytopenia in the ICU occurs in about 50% of patients, is multifactorial and is due to HIT in <1%. We aimed to describe the consequences of suspected HIT among medical-surgical critically ill patients in terms of drug and device management, and thrombotic outcomes.
We enrolled 3,746 patients in the PROTECT trial comparing prophylactic dalteparin to unfractionated heparin. We defined HIT as occurring in patients with a clinical or laboratory-driven suspicion of HIT and a positive serotonin release assay (SRA). We defined suspected HIT as patients whose clinicians were sufficiently concerned about HIT to withhold heparin. We defined consequences of HIT as occurring from 1 day before it was suspected to 30 days thereafter.
1 day before to 30 days after heparin held for suspect HIT
Any of the above drugs
Pneumatic compression device
Anti-embolic stockings or pneumatic compression device
Any of the above interventions
Venous thrombosis (including PE)
Progression of a previous thrombus
Any of the above
Over 90% of patients with suspected HIT did not have HIT. One-half of patients with suspected HIT were prescribed another anticoagulant and one-third received mechanical prophylaxis. Thrombotic rates are higher in patients with HIT and suspected HIT than other patients. The frequent suspicion of HIT in critically ill patients and initiation of other interventions may create a greater clinical and economic burden than HIT itself.
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