Heparin-induced thrombocytopenia (HIT) in 2011: An epidemic of overdiagnosis

Adam Cuker

doi:10.1160/TH11-09-0677

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(06): 993-994
DOI: 10.1160/TH11-09-0677

Invited Editorial Focus

Schattauer GmbH

Heparin-induced thrombocytopenia (HIT) in 2011: An epidemic of overdiagnosis

Adam Cuker

¹Department of Medicine and Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

› Author Affiliations

Abstract

Full Text

References

References
1 Amiral J, Bridey F, Dreyfus M. et al. Platelet factor 4 complexed to heparin is the target for antibodies generated in heparin-induced thrombocytopenia. Thromb Haemost 1992; 68: 95-96.
2 Weismann RE, Tobin RW. Arterial embolism occurring during systemic heparin therapy. Arch Surg 1958; 76: 219-227.
3 Warkentin TE. Think of HIT. Hematology Am Soc Hematol Educ Program 2006; 408-414.
4 Horner BM, Myers SR. Don’t miss HIT (heparin induced thrombocytopenia). Burns 2004; 30: 88-90.
5 Cuker A, Arepally G, Crowther MA. et al. The HIT Expert Probability (HEP) Score: a novel pre-test probability model for heparin-induced thrombocytopenia based on broad expert opinion. J Thromb Haemost 2010; 8: 2642-2650.
6 Crowther MA, Cook DJ, Albert M. et al. The 4Ts scoring system for heparin-induced thrombocytopenia in medical-surgical intensive care unit patients. J Crit Care 2010; 25: 287-293.
7 Berry C, Tcherniantchouk O, Ley EJ. et al. Overdiagnosis of heparin-induced thrombocytopenia in surgical ICU patients. J Am Coll Surg 2011; 213: 10-17.
8 Selleng S, Malowsky B, Strobel U. et al. Early-onset and persisting thrombocytopenia in post-cardiac surgery patients is rarely due to heparin-induced thrombocytopenia, even when antibody tests are positive. J Thromb Haemost 2010; 8: 30-36.
9 Smythe MA, Warkentin TE, Woodhouse AL, Zakalik D. Venous limb gangrene and fatal hemorrhage: adverse consequences of HIT “overdiagnosis” in a patient with antiphospholipid syndrome. Am J Hematol 2011; 86: 188-191.
10 Oliveira GB, Crespo EM, Becker RC. et al. Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy. Arch Intern Med 2008; 168: 94-102.
11 Lo GK, Juhl D, Warkentin TE. et al. Evaluation of pretest clinical score (4 T’s) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 2006; 4: 759-765.
12 Lo GK, Sigouin CS, Warkentin TE. What is the potential for overdiagnosis of heparin-induced thrombocytopenia?. Am J Hematol 2007; 82: 1037-1043.
13 Pauzner R, Greinacher A, Selleng K. et al. False-positive tests for heparin-induced thrombocytopenia in patients with antiphospholipid syndrome and systemic lupus erythematosus. J Thromb Haemost 2009; 7: 1070-1074.
14 Cuker A, Ortel TL. ASH evidence-based guidelines: is the IgG-specific anti-PF4/heparin ELISA superior to the polyspecific ELISA in the laboratory diagnosis of HIT?. Hematology Am Soc Hematol Educ Program 2009; 250-252.
15 Ruf KM, Bensadoun ES, Davis GA. et al. A clinical-laboratory algorithm incorporating optical density value to predict heparin-induced thrombocytopenia. Thromb Haemost 2011; 105: 553-559.
16 Whitlatch NL, Perry SL, Ortel TL. Anti-heparin/platelet factor 4 antibody optical density values and the confirmatory procedure in the diagnosis of heparin-induced thrombocytopenia. Thromb Haemost 2008; 100: 678-684.
17 Sachs U, von Hesberg J, Santoso S. et al. Evaluation of a new nanoparticle-based lateral-flow immunoassay for the exclusion of heparin-induced thrombocytopenia (HIT). Thromb Haemost 2011; 106: 1197-1202.
18 Cuker A. Heparin-induced thrombocytopenia: present and future. J Thromb Thrombolysis 2011; 31: 353-366.
19 Legnani C, Cini M, Pili C. et al. Evaluation of a new automated panel of assays for the detection of anti-PF4/heparin antibodies in patients suspected of having heparin-induced thrombocytopenia. Thromb Haemost 2010; 104: 402-409.
20 Pouplard C, Leroux D, Regina S. et al. Effectiveness of a new immunoassay for the diagnosis of heparin-induced thrombocytopenia and improved specificity when detecting IgG antibodies. Thromb Haemost 2010; 103: 145-150.
21 Davidson SJ, Ortel TL, Smith LJ. Performance of a new, rapid, automated immunoassay for the detection of anti-platelet factor 4/heparin complex antibodies. Blood Coagul Fibrinolysis 2011; 22: 340-344.