An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients
An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients
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DOI：
10.1001/archinte.163.20.2518
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发表时间：
2003-11-10
影响因子：
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通讯作者：
Kelton, JG
中科院分区：
文献类型：
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作者：
Warkentin, TE;Roberts, RS;Kelton, JG
背景：免疫肝素诱导的血小板减少症（HIT）的诊断通常基于血小板计数低于150 × 10(9)/L（血小板减少症的标准定义）。然而，这个定义可能不适合术后经常出现术后血小板增多的患者。我们试图确定一个改进的血小板减少的定义，表明骨科术后患者发生HIT，包括其对HIT发生频率和血栓形成风险的影响。方法：我们对665例选择性髋关节置换术后接受未分离或低分子量肝素治疗的患者的临床试验进行了二次分析。对所有患者进行每日血小板计数和深静脉血栓形成的客观研究。实验室检测来自362例患者亚组的HIT抗体用于确定各种血小板减少定义的敏感性和特异性，以指示HIT。结果：改进后的HIT定义为血小板计数从术后峰值下降50%或更多，因为与标准定义相比，该定义在检测HIT- igg方面具有更高的灵敏度（50% vs 25%）和相似的高特异性（99.1% vs 99.4%）。使用改进的定义确定的HIT患者血栓形成的频率高于未HIT患者(72.2% vs 17.3%； P
Background: Diagnosis of immune heparin-induced thrombocytopenia (HIT) is usually based on a fall in platelet count below 150 X 10(9)/L (standard definition of thrombocytopenia). However, this definition may be inappropriate for postoperative patients who often develop postoperative thrombocytosis. We sought to determine an improved definition of thrombocytopenia indicating HIT in postoperative orthopedic patients, including its impact on frequency and thrombotic risk of HIT.Methods: We performed a secondary analysis of a clinical trial of 665 patients who received unfractionated or low-molecular-weight heparin following elective hip arthroplasty. Daily platelet counts and objective studies for deep vein thrombosis were performed in all patients. Laboratory detection of HIT antibodies from a 362-patient subgroup was used to define sensitivity and specificity of various definitions of thrombocytopenia to indicate HIT.Results: The improved definition of HIT was a 50% or greater platelet count fall from the postoperative peak, as this definition had greater sensitivity (50% vs 25%) and similar high specificity (99.1% vs 99.4%) for detecting HIT-IgG compared with the standard definition. Patients with HIT who were identified using the improved definition had a higher frequency of thrombosis than patients without HIT (72.2% vs 17.3%; P