Work

Bleeding and thrombotic events in patients with heparin-induced thrombocytopenia: a two-decade single-center experience in Thailand

Year: 2025

Type: article

Abstract: Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder with potential bleeding complications, yet data from Asian populations are scarce. Our study aims to determine bleeding and thrombotic incidence and identify associated factors in Thai HIT patients. We retrospectively and prospectively studied patients with suspected or confirmed HIT at Siriraj Hospital (January 2004‒December 2024). Fondaparinux was the sole non-heparin anticoagulant. Suspected HIT required a positive immunoassay or platelet aggregation test. Forty-one patients (mean age, 66.8 years) were included, of whom 33 had confirmed HIT. Five had thrombosis, 16 (39%) required intensive-care-unit admission, and 29 (70.7%) had renal impairment. Among these 29, 13 developed new-onset acute kidney injury, and 16 had pre-existing renal disease (14 progressed to acute kidney injury). Most received fondaparinux (n = 25), whereas 5 received regional citrate, 1 warfarin, and 10 no anticoagulation. Overall mortality was 29.3%. One non-anticoagulated patient developed pulmonary embolism. Bleeding incidence was 1.22% per day, affecting 11 patients (26.8%), of whom 10 had renal impairment and 7 met International Society on Thrombosis and Haemostasis criteria for major bleeding. Bleeding rates did not differ between confirmed and suspected HIT (24.2% vs. 37.5%; P = .658). Pre-existing chronic kidney disease (hazard ratio, 2.78; 95% CI, 0.84‒9.26; P = .095) and sustained low-efficiency dialysis (hazard ratio, 4.60; 95% CI, 1.50‒14.09; P = .008) were associated with bleeding. In this Thai cohort, HIT conferred a high bleeding risk, especially in patients with renal impairment. These findings underscore the need for renal-safe non-heparin anticoagulants in resource-limited settings. TCTR20241227001. • Heparin-induced thrombocytopenia (HIT) is a prothrombotic condition that also carries a risk of bleeding. • Bleeding complications are especially concerning in patients with renal impairment. • Most available data on HIT come from Western populations; evidence from Asian populations remains limited. • In many Asian healthcare settings, treatment choices are restricted—fondaparinux, a renally excreted anticoagulant, is often the only non-heparin option, raising concerns in patients with kidney dysfunction. • We conducted a 20-year ambispective study at Siriraj Hospital, Thailand’s largest tertiary-care center. • A total of 41 patients with suspected or confirmed HIT were included; 70.7% had renal insufficiency. • Fondaparinux was the most commonly used anticoagulant. • Thrombotic events occurred in 12.2% of patients—lower than previously reported in Western populations. • Bleeding occurred in 26.8% of patients, most of whom had renal impairment. • The study highlights the substantial bleeding risk in HIT patients with renal impairment, especially in settings where fondaparinux is the only available treatment. • Thrombotic rates were lower than expected, suggesting that current anticoagulation intensity may not be optimal in Asian populations. • These findings support the need for individualized anticoagulation strategies that consider both thrombotic and bleeding risks. • There is a critical need for renal-safe anticoagulant options in resource-limited environments.

Source: Thrombosis Journal

DOI: 10.1186/s12959-025-00791-z

Authors: Yotsathon Chantarawichian, Bundarika Suwanawiboon, Theera Ruchutrakool, Yingyong Chinthammitr, Tarinee Rungjirajittranon

Institutions: Siriraj Hospital, Mahidol University

Language: English

Topic: Heparin-Induced Thrombocytopenia and Thrombosis

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090