Overdiagnosis of Heparin-Induced Thrombocytopenia in Surgical ICU Patients
Overdiagnosis of Heparin-Induced Thrombocytopenia in Surgical ICU Patients
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DOI：
10.1016/j.jamcollsurg.2011.04.002
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发表时间：
2011-07-01
影响因子：
5.2
通讯作者：
Margulies, Daniel R.
中科院分区：
文献类型：
--
作者：
Berry, Cherisse;Tcherniantchouk, Oxana;Margulies, Daniel R.
背景：手术患者使用肝素会增加发生肝素诱导性血小板减少症（HIT）的风险。HIT使用目前的标准标准的假阳性率是未知的外科ICU患者，谁往往有混杂因素，导致thrombointment.Study设计：外科ICU患者，入院超过2年的时间与HIT阳性筛选试验（血小板因子[PF] 4>= 0.4光密度[OD]），回顾性分析在一个单一的机构。进行Warkentin 4-T评分和商业肝素PF 4 ELISA与5-羟色胺释放测定（SRA）的相关性。使用逻辑回归来确定与HIT发生相关的独立危险因素。结果：基于临床怀疑HIT，对643名患者进行了PF 4检测。其中，104例患者的PF4结果、SRA值（%）和4-T评分可用。20名患者（19%）具有真阳性HIT，定义为PF4阳性和SRA阳性（SRA>= 20%）。84例患者（81%）为假阳性，定义为PF4阳性和SRA阴性。Warkentin评分为0~3分的58例患者中有5例，Warkentin评分为6~8分的14例患者中有6例经SRA检测为HIT阳性。结论：在外科ICU患者中，临床怀疑HIT需要PF4和SRA分析。HIT检测或直接凝血酶抑制剂治疗不应仅依赖于Warkentin 4-T评分。虽然PF4>= 0.4 OD被认为是HIT的阳性筛选试验，但PF4>= 2.0 OD在外科ICU患者中更可取。（美国科尔外科杂志2011; 213：10 - 18。(C)2011年美国外科医生学会）
BACKGROUND: Heparin use in surgical patients places them at increased risk for developing heparin-induced thrombocytopenia (HIT). The false positive rate of HIT using the current standard criteria is unknown in surgical ICU patients, who often have confounding factors that cause thrombocytopenia.STUDY DESIGN: Surgical ICU patients, admitted over a 2-year period with a positive screening test for HIT (platelet factor [PF] 4 >= 0.4 optical density [OD]), were reviewed retrospectively at a single institution. Correlation of the Warkentin 4-T score and commercial heparin PF4 ELISA with serotonin releasing assay (SRA) was performed. Logistic regression was used to determine independent risk factors associated with the development of HIT.RESULTS: PF4 tests were requested in 643 patients based on a clinical suspicion of HIT. Of these, 104 patients had a PF4 result, an SRA value (%), and a 4-T score available. Twenty patients (19%) had true positive HIT, defined as a positive PF4 and positive SRA (SRA >= 20%). Eighty-four patients (81%) were false positive, defined as a positive PF4 and negative SRA. Five of 58 patients with Warkentin score of 0 to 3, and 6 of 14 patients with Warkentin score of 6 to 8 were HIT positive by SRA.CONCLUSIONS: In surgical ICU patients, clinical suspicion for HIT necessitates PF4 and SRA analysis. Testing for HIT or treatment with a direct thrombin inhibitor should not depend on the Warkentin 4-T score alone. Although a PF4 >= 0.4 OD is considered a positive screening test for HIT, a PF4 >= 2.0 OD is preferable in surgical ICU patients. (J Am Coll Surg 2011; 213: 10-18. (C) 2011 by the American College of Surgeons)