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Prognostic factors for patients with heparin-induced thrombocytopenia: a systematic review

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Abstract

Background  Little is known with regards to the prognostic factors for patients with suspected or diagnosed Heparin-Induced Thromobocytopenia (HIT). The role of patient and therapy characteristics may play a role in predicting the outcome. Aim of the review To investigate the role of patient and therapy characteristics as potential prognostic factors for HIT-related complications (haemorrhagic and thromboembolic events), and mortality. Method The present systematic review was conducted according to the PRISMA statement. In September 2020, the main online databases were accessed: Pubmed, EMBASE, Scopus, Google Scholar. All the clinical trials concerning the management of patients with suspected or confirmed HIT were eligible. Studies evaluating the use of oral anticoagulants (e.g. vitamin K antagonists, Apixaban) were not considered, along with those comparing the use of heparin. For pairwise correlation, the Pearson Product-Moment Correlation Coefficient (r) was used. The final effect was evaluated according to the Cauchy–Schwarz inequality.Results Data from 33 clinical studies (4338 patients) were retrieved. The overall mean age was 62.3 ± 6.6 years old. Patients with HIT-related thromboembolism at the moment of diagnosis were associated with greater rate of haemorrhages (P > 0.0001), thromboembolism (P > 0.0001) and mortality (P = 0.001). Patients with more comorbidities at diagnosis were associated with a greater risk of haemorrhages (P = 0.07), thromboembolism (P = 0.002) and mortality (P = 0.002). Patients with longer duration of the therapy were associated with lower rate of mortality (P = 0.04). ConclusionsPatient comorbidities, presence of HIT-related thromboembolism on admission and shorter anticoagulant therapy were found to be negative prognostic factors. Thrombocythemia on admission, patients age and gender did not influence the overall outcome.

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  1. Department of Cardiac and Thoracic Surgery, RWTH Aachen University Clinic, Pauwelstr. 31, Aachen, 52074, Germany

    Giorgia Colarossi, Heike Schnöring & Nima Hatam

  2. Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Andromahi Trivellas

  3. Women´s College Hospital, University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Toronto, ON, Canada

    Marcel Betsch

  4. Department of Orthopaedics Surgery, RWTH Aachen University Clinic, Pauwelstr. 31, Aachen, 52074, Germany

    Jörg Eschweiler, Markus Tingart & Filippo Migliorini

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Colarossi, G., Schnöring, H., Trivellas, A. et al. Prognostic factors for patients with heparin-induced thrombocytopenia: a systematic review. Int J Clin Pharm 43, 449–460 (2021). https://doi.org/10.1007/s11096-020-01166-2

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