Timely diagnosis and management of heparin-induced thrombocytopenia in a frequent request, low incidence single centre using clinical 4T's score and particle gel immunoassay
Timely diagnosis and management of heparin-induced thrombocytopenia in a frequent request, low incidence single centre using clinical 4T's score and particle gel immunoassay
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DOI：
10.1111/j.1365-2141.2008.07401.x
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发表时间：
2008-12-01
影响因子：
6.5
通讯作者：
Joseph, Joanne E.
中科院分区：
文献类型：
--
作者：
Bryant, Adam;Low, Joyce;Joseph, Joanne E.
临床医生必须迅速决定哪些疑似患有肝素诱导的血小板减少症(HIT)的患者需要更换抗凝药物。这项由246例HIT检测转诊组成的单中心系列评估了临床评分(血小板减少、时间、血栓形成、其他原因不明显的血小板减少；4T)、重命名ID-肝素-PF4免疫分析(PaGIA)和14C-5-羟色胺释放分析(SRA)的组合，以开发一种实用而安全的HIT诊断策略。4T评分低的患者共转诊142/256例(58%)，高评分组转诊12/246例(5%)。PaGIA阳性24例(9.7%)，SRA阳性9例(3.6%)。单独一项PaGIA阳性试验的总体阳性预测值为37.5%，但高分组者的阳性预测值达到80%。PaGIA阴性者和临床评分低者的阴性预测值均为100%。我们随后开发了一种算法，当应用于该队列时，将导致18/246名患者(7%)肯定需要替代抗凝，而另外7/246名患者(2.8%)将被单独考虑。最终(根据SRA)，这将导致16/246(6.5%)患者不必要地改变他们的抗凝状态，其中9/246(3.6%)患者得到“正确治疗”。4T评分和PaGIA的结合使得快速诊断和处理HIT成为一种实用和安全的方法。
Clinicians must promptly decide which patients suspected of having heparin-induced thrombocytopenia (HIT) warrant a change in anticoagulation. This single-centre series of 246 HIT testing referrals assessed the combination of clinical score (thrombocytopenia, timing, thrombosis, other causes of thrombocytopenia not evident; 4T's), Diamed ID-Heparin-PF4 immunoassay (PaGIA) and 14C Serotonin Release Assay (SRA) to develop a practical and safe diagnostic strategy for HIT. A total of 142/256 (58%) referrals were in patients with a low 4T's score, with 12/246 (5%) in the high scoring group. PaGIA was positive in 24/246 (9.7%) patients, whilst SRA was positive in 9/246 (3.6%). The overall positive predictive value of a positive PaGIA test alone was 37.5%, however this reached 80% for the high scoring group. Both negative PaGIA and low clinical score independently had negative predictive values of 100%. We subsequently developed an algorithm that, when applied to this cohort, would have resulted in 18/246 patients (7%) definitely requiring alternative anticoagulation, whilst a further 7/246 (2.8%) patients would have been considered on an individual basis. Ultimately (based on SRA) this would have resulted in 16/246 (6.5%) patients unnecessarily having a change in their anticoagulation, with 9/246 (3.6%) patients being 'correctly treated'. The combination of 4T's scoring and PaGIA permitted a practical and safe approach to rapid HIT diagnosis and management.