Heparin-induced thrombocytopenia in extra-corporeal membrane oxygenation: epidemiology, outcomes, and diagnostic challenges.
Heparin-induced thrombocytopenia in extra-corporeal membrane oxygenation: epidemiology, outcomes, and diagnostic challenges.
- 2022
To describe the prevalence of heparin-induced thrombocytopenia (HIT) in patients on extracorporeal membrane oxygenation (ECMO) and to explore ways to improve the diagnostic accuracy of the HIT enzyme-linked immunosorbent assay (ELISA). Retrospective review of all patients needing ECMO between September 2011 and September 2020 who underwent evaluation for HIT while on ECMO. The diagnosis of HIT required a confirmatory serotonin release assay (SRA). Various break points for the optical density (OD) that defines a positive HIT ELISA were examined to estimate their utility as screening tests for HIT. Patient outcomes served as a secondary endpoint. Among 417 ECMO patients, 162 (38.8%) had a HIT ELISA. Of these, 114 (70.4%) had a subsequent SRA. Although the HIT ELISA was positive at an OD >= 0.4 in 1/3rd of subjects, only 15 subjects met criteria for HIT by SRA. Hence, the prevalence of HIT equaled 3.6%. At an OD >= 0.4 the ELISA had both poor specificity (71.7%) and accuracy (74.6%). Changing the definition of the ELISA to an OD >= 1.2 improved both specificity and accuracy with only a limited impact on sensitivity. Nearly 60% of those with HIT developing during ECMO died. HIT is infrequent in persons requiring ECMO. However, HIT remains associated with substantial mortality. The HIT ELISA as currently implemented performs poorly as a screening test and likely results in the unnecessary overuse of alternatives to unfractionated heparin. Altering the definition of a positive OD improves the HIT ELISA's accuracy. Copyright (c) 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
English
0929-5305
*Extracorporeal Membrane Oxygenation
*Thrombocytopenia
Anticoagulants/ae [Adverse Effects]
Enzyme-Linked Immunosorbent Assay/mt [Methods]
Extracorporeal Membrane Oxygenation/ae [Adverse Effects]
Heparin/ae [Adverse Effects]
Humans
Platelet Factor 4
Thrombocytopenia/ci [Chemically Induced]
Thrombocytopenia/di [Diagnosis]
Thrombocytopenia/ep [Epidemiology]
MedStar Washington Hospital Center
Medicine/Pulmonary-Critical Care
Pulmonary/Critical Care Fellowship
Journal Article
To describe the prevalence of heparin-induced thrombocytopenia (HIT) in patients on extracorporeal membrane oxygenation (ECMO) and to explore ways to improve the diagnostic accuracy of the HIT enzyme-linked immunosorbent assay (ELISA). Retrospective review of all patients needing ECMO between September 2011 and September 2020 who underwent evaluation for HIT while on ECMO. The diagnosis of HIT required a confirmatory serotonin release assay (SRA). Various break points for the optical density (OD) that defines a positive HIT ELISA were examined to estimate their utility as screening tests for HIT. Patient outcomes served as a secondary endpoint. Among 417 ECMO patients, 162 (38.8%) had a HIT ELISA. Of these, 114 (70.4%) had a subsequent SRA. Although the HIT ELISA was positive at an OD >= 0.4 in 1/3rd of subjects, only 15 subjects met criteria for HIT by SRA. Hence, the prevalence of HIT equaled 3.6%. At an OD >= 0.4 the ELISA had both poor specificity (71.7%) and accuracy (74.6%). Changing the definition of the ELISA to an OD >= 1.2 improved both specificity and accuracy with only a limited impact on sensitivity. Nearly 60% of those with HIT developing during ECMO died. HIT is infrequent in persons requiring ECMO. However, HIT remains associated with substantial mortality. The HIT ELISA as currently implemented performs poorly as a screening test and likely results in the unnecessary overuse of alternatives to unfractionated heparin. Altering the definition of a positive OD improves the HIT ELISA's accuracy. Copyright (c) 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
English
0929-5305
*Extracorporeal Membrane Oxygenation
*Thrombocytopenia
Anticoagulants/ae [Adverse Effects]
Enzyme-Linked Immunosorbent Assay/mt [Methods]
Extracorporeal Membrane Oxygenation/ae [Adverse Effects]
Heparin/ae [Adverse Effects]
Humans
Platelet Factor 4
Thrombocytopenia/ci [Chemically Induced]
Thrombocytopenia/di [Diagnosis]
Thrombocytopenia/ep [Epidemiology]
MedStar Washington Hospital Center
Medicine/Pulmonary-Critical Care
Pulmonary/Critical Care Fellowship
Journal Article