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Outcomes of patients with suspected heparin-induced thrombocytopenia in a contemporary multicenter cohort

Year: 2025

Type: article

Abstract: Managing patients with suspected heparin-induced thrombocytopenia (HIT) poses significant clinical challenges. Limited evidence exists on how management decisions impact clinical outcomes, leading to treatment recommendations based on low-certainty evidence. This study aimed to evaluate the treatment strategies and clinical outcomes of patients with suspected HIT in a contemporary multicenter cohort. We conducted a prospective, multicenter cohort study including consecutive patients with suspected HIT from 11 centers. Patients were stratified into 3 groups: (1) HIT confirmed, (2) HIT-negative but heparin/platelet factor 4 (PF4) antibody-positive, and (3) HIT-negative without antibodies. Clinical and laboratory data were systematically collected. HIT was diagnosed using the washed-platelet heparin-induced platelet activation test as the reference standard. Among 1393 patients (46% female, median age 67 years), HIT was confirmed in 119 (8.5%). Most patients were in intensive care (37%), or had undergone cardiac surgery (32%). Argatroban was the predominant treatment (70%), and platelet recovery occurred in 77% of patients with HIT. Among patients with HIT, subsequent venous thromboembolism occurred in 23%, arterial thromboembolism in 9%, major bleeding in 12.6%, and mortality in 18%, with no significant differences between anticoagulants. Treatment with argatroban, bivalirudin, or direct oral anticoagulants (DOACs) significantly reduced arterial thromboembolism risk. Outcomes did not differ between patients who were HIT-negative with or without heparin/PF4 antibodies. HIT, as well as the mere suspicion of HIT, remains a serious condition with a high risk of adverse outcomes, including death. Our findings provide further evidence supporting the effectiveness of DOACs, argatroban, and bivalirudin in reducing arterial thromboembolism risk.

Source: Zurich Open Repository and Archive (University of Zurich)

DOI: 10.5167/uzh-281355

Authors: Nilius, Henning, Sinitsa, Ekaterina, Studt, Jan-Dirk, Tsakiris, Dimitrios A, Greinacher, Andreas, Mendez, Adriana, Schmidt, Adrian, Wuillemin, Walter A, Gerber, Bernhard, Vishnu, Prakash, Graf, Lukas, Kremer Hovinga, Johanna A, Bakchoul, Tamam, Nagler, Michael

Language: English

Topic: Heparin-Induced Thrombocytopenia and Thrombosis

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

OpenAlex ID: W7115016484

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