Heparin-induced thrombocytopenia in extra-corporeal membrane oxygenation: epidemiology, outcomes, and diagnostic challenges.

MedStar author(s):
Citation: Journal of Thrombosis & Thrombolysis. 53(2):499-505, 2022 Feb.PMID: 34341895Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical Care | Pulmonary/Critical Care FellowshipForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2022ISSN:
  • 0929-5305
Name of journal: Journal of thrombosis and thrombolysisAbstract: 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.All authors: Brammer RC, Chan CM, Shorr AF, Zaaqoq AMOriginally published: Journal of Thrombosis & Thrombolysis. 2021 Aug 02Fiscal year: FY2022Digital Object Identifier: ORCID: Date added to catalog: 2021-11-01
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Journal Article MedStar Authors Catalog Article 34341895 Available 34341895

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.

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