Heparin-induced thrombocytopenia type II in a surgical intensive care unit

• Published in: Journal of critical care 2012-06, Vol.27 (3), p.232-241
• Main Authors: Sakr, Yasser, MD, PhD, Haetscher, Friederike, MD, Gonsalves, Mateus Demarchi, MD, Hoffman, Michael, MD, Theis, Bernhard, MD, Barz, Dagmar, MD, Reinhart, Konrad, MD, Kortgen, Andreas, MD
• Format: Article
• Language: English
• Subjects: Aged; Anticoagulants - adverse effects; Coagulopathy; Critical Care; Epidemiology; Female; Germany - epidemiology; Heparin; Heparin - adverse effects; Hospital Mortality; Hospitals; Humans; Incidence; Intensive care; Intensive Care Units - statistics & numerical data; Logistic Models; Male; Matched-Pair Analysis; Medical treatment; Middle Aged; Molecular weight; Mortality; Multivariate Analysis; Platelet Count; Postoperative; Postoperative Complications - chemically induced; Postoperative Complications - epidemiology; Postoperative Complications - therapy; Prevalence; Prognosis; Retrospective Studies; Risk assessment; Thrombocytopenia; Thrombocytopenia - chemically induced; Thrombocytopenia - epidemiology; Thrombocytopenia - therapy; Treatment Outcome
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2011.06.016

Abstract Purpose The aim of this study was to investigate the epidemiology of and outcome from heparin-induced thrombocytopenia type II (HIT) in surgical intensive care unit (ICU) patients. Patients and Methods All 13 948 patients admitted to a university hospital surgical ICU between January 2004 and March 2008 were included in this retrospective cohort study. Results Of 349 patients with a clinical suspicion of HIT, 88 patients had platelet factor 4/heparin antibodies using enzyme-linked immunosorbent assay. The prevalence and incidence of HIT were 0.82% and 0.63%, respectively. The complication rate was 43.5%, and the ICU and hospital mortality rates were 23.9% and 33%, respectively. In a multivariable analysis, the nadir platelet count (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P = .048) was the only factor independently associated with risk of death in these patients. In a nested matched case-control analysis, mortality rates were similar in patients with HIT and in the matched controls. However, complication rates were higher, and ICU and hospital lengths of stay were longer in patients with HIT compared with those of the control group. Conclusions In this cohort of surgical ICU patients, HIT was associated with increased morbidity but not mortality rates compared with a nested matched control group. The nadir platelet count was independently associated with a higher risk of inhospital death in these patients.