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Journal of Thrombosis and Thrombolysis

, Volume 45, Issue 4, pp 536–542 | Cite as

Platelet response to direct thrombin inhibitor or fondaparinux treatment in patients with suspected heparin-induced thrombocytopenia

  • Tiffany K. Pon
  • Anjlee Mahajan
  • Aaron Rosenberg
  • Alpesh Amin
  • Digish Shah
  • Ian Jenkins
  • Vineet Gupta
  • Heather Hofmann
  • Anthony Bejjani
  • Richard White
Article

Abstract

Making a definitive diagnosis of heparin-induced thrombocytopenia (HIT) can be problematic. A prompt platelet rise following treatment has been proposed as a “post-test” criterion for diagnosis. However, the platelet response following discontinuation of heparin and initiation of a recommended alternative anticoagulant remains largely undefined and unstudied. This study aimed to characterize platelet response to initial treatment in patients with a low, intermediate, or high likelihood of having HIT. This was a multicenter retrospective cohort study. Patients were over 18 years in age, underwent serologic testing for HIT, and received alternative anticoagulation treatment for HIT. Classification of each patient’s likelihood of having HIT was based on an empiric, pre-hoc combination of the 4T score and serology results. The primary outcome for this study was a platelet count response after initiation of direct thrombin inhibitor (DTI) or fondaparinux therapy within 48 h. 124 patients were analyzed. The sensitivity and specificity of having an immediate platelet rise of at least 10,000/µL by day 2 after starting treatment among high-likelihood for HIT patients were 0.71 (95% CI 0.55–0.84) and 0.64 (95% CI 0.5–0.76), respectively. The negative predictive value of no platelet rise was 75.5% (95% CI 0.61–0.86). A prompt platelet count rise may be appropriate to consider along with other known criteria for the clinical diagnosis of HIT. The rise should be immediate following discontinuation of heparin and initiation of recommended treatment, with an upward rise within 48 h.

Keywords

Anticoagulants Diagnosis Heparin Platelet count Thrombocytopenia 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Tiffany K. Pon
    • 1
    • 2
  • Anjlee Mahajan
    • 1
    • 2
  • Aaron Rosenberg
    • 1
  • Alpesh Amin
    • 3
  • Digish Shah
    • 4
  • Ian Jenkins
    • 5
  • Vineet Gupta
    • 5
  • Heather Hofmann
    • 3
  • Anthony Bejjani
    • 4
  • Richard White
    • 1
  1. 1.University of California, Davis Medical CenterSacramentoUSA
  2. 2.University of California, San Francisco Medical CenterSan FranciscoUSA
  3. 3.University of California, Irvine Medical CenterOrangeUSA
  4. 4.University of California, Los Angeles Medical CenterLos AngelesUSA
  5. 5.University of California, San Diego Medical CenterSan DiegoUSA

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