Allyson M Pishko1, Daniel S Lefler1, Phyllis Gimotty2, Koosha Paydary3, Sara Fardin4, Gowthami M Arepally5, Mark Crowther6, Lawrence Rice7, Rolando Vega1, Douglas B Cines1,8, James P Guevara2,9, Adam Cuker1,8. 1. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 2. Department of Biostatistics and Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois. 4. Department of Radiology, Tufts Medical Center, Boston, Massachusetts. 5. Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina. 6. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 7. Hematology Division, Department of Medicine, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas. 8. Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 9. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding. OBJECTIVES: To determine the incidence of major bleeding in patients with suspected HIT. METHODS: We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT-) and exposure to an alternative anticoagulant (Tx+ or Tx-). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality. RESULTS: The incidence of major bleeding was high in the HIT+Tx+, HIT- Tx+, and HIT-Tx- groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P = .24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44-3.47), platelet count < 25 × 109 /L (HR 2.13, 1.10-4.12), and renal dysfunction (HR 1.56, 1.06-2.27); 35.7% of HIT+Tx+, 13.8% HIT-Tx+, and 9.3% of HIT-Tx- patients experienced new or progressive thrombosis. Mortality was similar among the three groups (26.2% HIT+Tx+, 34.5% HIT-Tx+, and 26.7% of HIT-Tx- [P = .34]). CONCLUSIONS: Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.
BACKGROUND: The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding. OBJECTIVES: To determine the incidence of major bleeding in patients with suspected HIT. METHODS: We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT-) and exposure to an alternative anticoagulant (Tx+ or Tx-). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality. RESULTS: The incidence of major bleeding was high in the HIT+Tx+, HIT- Tx+, and HIT-Tx- groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P = .24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44-3.47), platelet count < 25 × 109 /L (HR 2.13, 1.10-4.12), and renal dysfunction (HR 1.56, 1.06-2.27); 35.7% of HIT+Tx+, 13.8% HIT-Tx+, and 9.3% of HIT-Tx- patients experienced new or progressive thrombosis. Mortality was similar among the three groups (26.2% HIT+Tx+, 34.5% HIT-Tx+, and 26.7% of HIT-Tx- [P = .34]). CONCLUSIONS: Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.
Authors: L Joseph; A I Casanegra; M Dhariwal; M A Smith; M G Raju; M A Militello; M P Gomes; H L Gornik; J R Bartholomew Journal: J Thromb Haemost Date: 2014-06-19 Impact factor: 5.824
Authors: Serdar Akca; Philip Haji-Michael; Arnaldo de Mendonça; Peter Suter; Marcel Levi; Jean Louis Vincent Journal: Crit Care Med Date: 2002-04 Impact factor: 7.598
Authors: Adam Cuker; Gowthami M Arepally; Beng H Chong; Douglas B Cines; Andreas Greinacher; Yves Gruel; Lori A Linkins; Stephen B Rodner; Sixten Selleng; Theodore E Warkentin; Ashleigh Wex; Reem A Mustafa; Rebecca L Morgan; Nancy Santesso Journal: Blood Adv Date: 2018-11-27
Authors: Bruce Doepker; Kari L Mount; Lindsay J Ryder; Anthony T Gerlach; Claire V Murphy; Gary S Philips Journal: J Thromb Thrombolysis Date: 2012-11 Impact factor: 2.300
Authors: David J Kuter; Barbara A Konkle; Taye H Hamza; Lynne Uhl; Susan F Assmann; Joseph E Kiss; Richard M Kaufman; Nigel S Key; Bruce S Sachais; John R Hess; Paul Ness; Keith R McCrae; Cindy Leissinger; Ronald G Strauss; Janice G McFarland; Ellis Neufeld; James B Bussel; Thomas L Ortel Journal: Am J Hematol Date: 2017-04-26 Impact factor: 10.047
Authors: Christine S M Lee; Maria V Selvadurai; Leonardo Pasalic; James Yeung; Maria Konda; Geoffrey W Kershaw; Emmanuel J Favaloro; Vivien M Chen Journal: J Thromb Haemost Date: 2022-02-07 Impact factor: 16.036
Authors: Sanjay Khandelwal; Ayiesha Barnes; Lubica Rauova; Amrita Sarkar; Ann H Rux; Serge V Yarovoi; S Sergei Zaitsev; John D Lambris; Sooho S Myoung; Alexandra Johnson; Grace M Lee; Madelaine Duarte; Mortimer Poncz; Gowthami M Arepally; Douglas B Cines Journal: Blood Date: 2021-11-25 Impact factor: 22.113
Authors: Bethany Samuelson Bannow; Deepti M Warad; Curtis G Jones; Shannon M Pechauer; Brian R Curtis; Daniel W Bougie; Ruchika Sharma; Diane E Grill; Mary W Redman; Parisa R Khalighi; Rachel R Leger; Rajiv K Pruthi; Dong Chen; Daniel E Sabath; Richard H Aster; David A Garcia; Anand Padmanabhan Journal: Blood Date: 2021-02-25 Impact factor: 25.476