Cardiothoracic and Vascular Anesthesia
Prevalence and Risk of Preexisting Heparin-Induced Thrombocytopenia Antibodies in Patients With Acute VTE
Warkentin TE, Davidson BL, Büller HR, et al (McMaster Univ, Hamilton, Ontario, Canada; Univ of Washington, School of Medicine, Seattle; Academic Med Ctr, Amsterdam, The Netherlands; et al) Chest 140:366-373, 2011§
Evidence Ranking
• A
Expert Rating
• 2
Abstract
Background
Some patients with acute VTE who may previously have been exposed to heparin products have unrecognized antibodies implicated in heparin-induced thrombocytopenia (HIT). Antibody prevalence and patient consequences upon exposure to heparin, low-molecular-weight heparin, and fondaparinux are uncertain.
Methods
In this secondary analysis, we tested patients in the Matisse VTE studies at study entry for heparin-dependent antibodies and further tested patients with enzyme-linked immunosorbent assay (ELISA)-positive results for platelet-activating antibodies. We compared the risk of HIT (>50% fall in platelet count, heparin-dependent antibodies, no contradicting features) between patients treated with heparin (either unfractionated or low molecular weight [enoxaparin]) vs those who received fondaparinux. Comparison groups for thrombocytopenia occurrence comprised patients with ELISA-positive, platelet-activating, antibody-positive results; ELISA-positive, but platelet-activating antibody-negative results; and randomly selected antibody-negative results.
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