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Incidence and clinical outcomes of heparin-induced thrombocytopenia: 11 year experience in a tertiary care university hospital

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Abstract

Heparin-induced thrombocytopenia (HIT) is a rare immuno-mediated adverse reaction with high thrombotic and mortality risk. To evaluate incidence and outcomes of HIT cases diagnosed at a tertiary care hospital from 2007 to 2018. A retrospective study was conducted. Patients with suspected HIT underwent 4Ts score assessment and anti-heparin PF4 IgG antibodies ELISA screening test. If the latter was positive, platelet aggregation test (PAT) was performed. If the latter was positive, any form of heparin was stopped, alternative anticoagulants were started and then overlapped with warfarin. HIT incidence was calculated by dividing HIT cases by the mean yearly number of admitted patients over 11 years. Follow-up was 90 days. Among 2125 screening tests, 96 (4.5%) were positive with confirmatory PAT in 82/90 (3.8% for missing data in 6). Median age was 75; 39 patients were surgical and 51 medical. The median 4Ts score was 5. Unfractionated heparin was employed in 34 (37%). HIT incidence was 0.16/1000/patient/years (95% CI: 0.12–0.23) in surgical and 0.15/1000/patient/years (95%: 0.12–0.20) in medical patients. HIT with thrombosis (HIT-T) was observed in 31 patients (0.05/1000/patient/years 95% CI: 0.04–0.1), with venous thromboses in 25 (80%). HIT without thrombosis was observed in 59 patients (0.1/1000 patient/years; 95% CI: 0.08–0.13, twofold vs HIT-T). All cause mortality was 25.5% (95% CI: 17.6–35.4), major bleeding 7.7% (95% CI:3.2–15.3), and thromboembolic complications 3.3% (95% CI:1.1–9.3). HIT is a rare event with high mortality, despite the use of non heparin anticoagulants.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Angiology and Blood Coagulation Unit , IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Benilde Cosmi, Laura Borgese & Michelangelo Sartori

  2. Arianna Foundation, Bologna, Italy

    Cristina Legnani, Michela Cini & Gualtiero Palareti

  3. Angiology and Blood Coagulation Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Benilde Cosmi & Laura Borgese

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  1. Benilde Cosmi
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  2. Cristina Legnani
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Correspondence to Benilde Cosmi.

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This article does not contain studies directly involving human participants as it is a review of data already collected in a database regarding patients diagnosed with heparin induced thrombocytopenia.

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Cosmi, B., Legnani, C., Cini, M. et al. Incidence and clinical outcomes of heparin-induced thrombocytopenia: 11 year experience in a tertiary care university hospital. Intern Emerg Med 18, 1971–1980 (2023). https://doi.org/10.1007/s11739-023-03379-5

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