Brijesh P Mehta1, John R Sims2, Carlos E Baccin3, Thabele M Leslie-Mazwi1, Christopher S Ogilvy4, Raul G Nogueira5. 1. Department of Neurology, Harvard Medical School, Boston, Mass., USA ; Department of Radiology, Harvard Medical School, Boston, Mass., USA. 2. Department of Neurology, Harvard Medical School, Boston, Mass., USA. 3. Department of Radiology, Harvard Medical School, Boston, Mass., USA. 4. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., USA. 5. Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA.
Abstract
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a dreaded complication of heparin-related products and correlates with a worse outcome in aneurysmal subarachnoid hemorrhage (SAH) patients. OBJECTIVE: To study the risk factors and outcomes of SAH patients suspected of having HIT, confirmed as present or absent by the platelet factor 4 (PF4) antibody test. METHODS: All patients with presumed aneurysmal, nontraumatic SAH and having undergone a PF4 test were identified through our research patient database. Charts, laboratory values and images were analyzed retrospectively. RESULTS: We identified 166 patients with SAH who were tested for HIT; 42 patients (25%) had a positive antibody test. There was no difference in platelet profiles or mean platelet nadirs of HIT+ and HIT- patients (147 ± 93 vs. 153 ± 86 ×10(9)/l, respectively). Univariate analysis identified gender, magnesium prophylaxis, Fisher group 3, clipping versus coiling, presence of angiographic vasospasm, number of vasospasm treatments, and day of HIT testing as potential risk factors associated with HIT. A multivariate analysis indicated that female gender (OR 8.2, 95% CI 2.0-33.2), greater number of vasospasm treatments (OR 1.5, 95% CI 1.2-2.0), later day of HIT testing (OR 1.2, 95% CI 1.1-1.3), and clipping (OR 5.0, 95% CI 1.42-10.0) were independently associated with HIT positivity. HIT+ patients showed more infarcts on CT, longer ICU and hospital stays and worse modified Rankin Scale scores on discharge. CONCLUSION: The presence of HIT in SAH has adverse consequences and is more likely in female patients who have undergone aneurysm clipping and require multiple endovascular vasospasm treatments.
BACKGROUND:Heparin-induced thrombocytopenia (HIT) is a dreaded complication of heparin-related products and correlates with a worse outcome in aneurysmal subarachnoid hemorrhage (SAH) patients. OBJECTIVE: To study the risk factors and outcomes of SAHpatients suspected of having HIT, confirmed as present or absent by the platelet factor 4 (PF4) antibody test. METHODS: All patients with presumed aneurysmal, nontraumatic SAH and having undergone a PF4 test were identified through our research patient database. Charts, laboratory values and images were analyzed retrospectively. RESULTS: We identified 166 patients with SAH who were tested for HIT; 42 patients (25%) had a positive antibody test. There was no difference in platelet profiles or mean platelet nadirs of HIT+ and HIT- patients (147 ± 93 vs. 153 ± 86 ×10(9)/l, respectively). Univariate analysis identified gender, magnesium prophylaxis, Fisher group 3, clipping versus coiling, presence of angiographic vasospasm, number of vasospasm treatments, and day of HIT testing as potential risk factors associated with HIT. A multivariate analysis indicated that female gender (OR 8.2, 95% CI 2.0-33.2), greater number of vasospasm treatments (OR 1.5, 95% CI 1.2-2.0), later day of HIT testing (OR 1.2, 95% CI 1.1-1.3), and clipping (OR 5.0, 95% CI 1.42-10.0) were independently associated with HIT positivity. HIT+ patients showed more infarcts on CT, longer ICU and hospital stays and worse modified Rankin Scale scores on discharge. CONCLUSION: The presence of HIT in SAH has adverse consequences and is more likely in female patients who have undergone aneurysm clipping and require multiple endovascular vasospasm treatments.
Authors: Daniel Friedlich; Celso Agner; Alan S Boulos; Fasil Mesfin; Paul Feustel; Gary L Bernardini; A John Popp Journal: Neurol Res Date: 2009-07 Impact factor: 2.448