Laboratory and demographic predictors of functional assay positive status in suspected heparin-induced thrombocytopenia: A multicenter retrospective cohort study

Heparin-induced thrombocytopenia (HIT) is an antibody-mediated immune response against platelet factor 4 (PF4) bound to heparin anticoagulants. A priori identification of patients at-risk for HIT remains elusive and a number of risk factors have been identified, but these associations and their effe...

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Published in:Thrombosis research 2023-09, Vol.229, p.198-208
Main Authors: Giles, Jason B., Rollin, Jerome, Martinez, Kiana L., Selleng, Kathleen, Thiele, Thomas, Pouplard, Claire, Sheppard, Jo-Ann I., Heddle, Nancy M., Phillips, Elizabeth J., Roden, Dan M., Gruel, Yves, Warkentin, Theodore E., Greinacher, Andreas, Karnes, Jason H.
Format: Article
Language:English
Subjects:
Adverse drug reaction
Anti-PF4/heparin antibodies
Anticoagulants - adverse effects
Demography
Female
Functional assay testing
Heparin
Heparin - adverse effects
Heparin-induced thrombocytopenia
Humans
Immunoglobulin A
Immunoglobulin G
Platelet Factor 4
Retrospective Studies
Risk factors
Thrombocytopenia - chemically induced
Thrombocytopenia - diagnosis
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Summary:Heparin-induced thrombocytopenia (HIT) is an antibody-mediated immune response against platelet factor 4 (PF4) bound to heparin anticoagulants. A priori identification of patients at-risk for HIT remains elusive and a number of risk factors have been identified, but these associations and their effect sizes have limited validation in large cohorts of suspected HIT patients. The aim of this study was to investigate existing anti-PF4/heparin antibody thresholds and model the relationship of demographic variables and anti-PF4/heparin antibody levels with functional assay positivity across multiple institutions in the absence of detailed clinical data. In a large collection of suspected HIT patients (n = 8904), we tested for associations between laboratory and demographic variables and functional assay positive status as well as anti-PF4/heparin antibody levels. We also tested for correlation between IgG-specific and polyspecific (IgG/IgA/IgM) anti-PF4/heparin antibody values and their ability to predict functional assay positive status using area under the receiver operating characteristic (AUROC). Logistic regression identified increasing anti-PF4/heparin antibody OD levels (OR = 51.84 [37.27–74.34], p 
ISSN:0049-3848
1879-2472
1879-2472
DOI:10.1016/j.thromres.2023.07.011