The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia

Research output: Contribution to journalArticle

Allyson M. Pishko, Daniel S. Lefler, Phyllis Gimotty, Koosha Paydary, Sara Fardin, Gowthami M. Arepally, Mark Crowther, Lawrence Rice, Rolando Vega, Douglas B. Cines, James P. Guevara, Adam Cuker

Background: The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding. Objectives: To determine the incidence of major bleeding in patients with suspected HIT. Methods: We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT−) and exposure to an alternative anticoagulant (Tx+ or Tx−). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality. Results: The incidence of major bleeding was high in the HIT+Tx+, HIT− Tx+, and HIT−Tx− groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P =.24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44-3.47), platelet count < 25 × 109/L (HR 2.13, 1.10-4.12), and renal dysfunction (HR 1.56, 1.06-2.27); 35.7% of HIT+Tx+, 13.8% HIT−Tx+, and 9.3% of HIT−Tx− patients experienced new or progressive thrombosis. Mortality was similar among the three groups (26.2% HIT+Tx+, 34.5% HIT−Tx+, and 26.7% of HIT−Tx− [P =.34]). Conclusions: Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.

Original languageEnglish (US)
Pages (from-to)1956-1965
Number of pages10
JournalJournal of Thrombosis and Haemostasis
Volume17
Issue number11
DOIs
StatePublished - Nov 1 2019

PMID: 31350937

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The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia. / Pishko, Allyson M.; Lefler, Daniel S.; Gimotty, Phyllis; Paydary, Koosha; Fardin, Sara; Arepally, Gowthami M.; Crowther, Mark; Rice, Lawrence; Vega, Rolando; Cines, Douglas B.; Guevara, James P.; Cuker, Adam.

In: Journal of Thrombosis and Haemostasis, Vol. 17, No. 11, 01.11.2019, p. 1956-1965.

Research output: Contribution to journalArticle

Harvard

Pishko, AM, Lefler, DS, Gimotty, P, Paydary, K, Fardin, S, Arepally, GM, Crowther, M, Rice, L, Vega, R, Cines, DB, Guevara, JP & Cuker, A 2019, 'The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia' Journal of Thrombosis and Haemostasis, vol. 17, no. 11, pp. 1956-1965. https://doi.org/10.1111/jth.14587

APA

Pishko, A. M., Lefler, D. S., Gimotty, P., Paydary, K., Fardin, S., Arepally, G. M., ... Cuker, A. (2019). The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia. Journal of Thrombosis and Haemostasis, 17(11), 1956-1965. https://doi.org/10.1111/jth.14587

Vancouver

Pishko AM, Lefler DS, Gimotty P, Paydary K, Fardin S, Arepally GM et al. The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia. Journal of Thrombosis and Haemostasis. 2019 Nov 1;17(11):1956-1965. https://doi.org/10.1111/jth.14587

Author

Pishko, Allyson M. ; Lefler, Daniel S. ; Gimotty, Phyllis ; Paydary, Koosha ; Fardin, Sara ; Arepally, Gowthami M. ; Crowther, Mark ; Rice, Lawrence ; Vega, Rolando ; Cines, Douglas B. ; Guevara, James P. ; Cuker, Adam. / The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia. In: Journal of Thrombosis and Haemostasis. 2019 ; Vol. 17, No. 11. pp. 1956-1965.

BibTeX

@article{01c185e97df64caaa8c37d4aed3c7e0d,
title = "The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia",
abstract = "Background: The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding. Objectives: To determine the incidence of major bleeding in patients with suspected HIT. Methods: We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT−) and exposure to an alternative anticoagulant (Tx+ or Tx−). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality. Results: The incidence of major bleeding was high in the HIT+Tx+, HIT− Tx+, and HIT−Tx− groups (35.7{\%}, 44.0{\%}, and 37.3{\%}, respectively). The time to first major bleeding event did not differ between groups (P =.24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95{\%} CI 1.44-3.47), platelet count < 25 × 109/L (HR 2.13, 1.10-4.12), and renal dysfunction (HR 1.56, 1.06-2.27); 35.7{\%} of HIT+Tx+, 13.8{\%} HIT−Tx+, and 9.3{\%} of HIT−Tx− patients experienced new or progressive thrombosis. Mortality was similar among the three groups (26.2{\%} HIT+Tx+, 34.5{\%} HIT−Tx+, and 26.7{\%} of HIT−Tx− [P =.34]). Conclusions: Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.",
keywords = "anticoagulants/adverse event, anticoagulants/therapeutic use, heparin/adverse event, thrombocytopenia, thrombosis",
author = "Pishko, {Allyson M.} and Lefler, {Daniel S.} and Phyllis Gimotty and Koosha Paydary and Sara Fardin and Arepally, {Gowthami M.} and Mark Crowther and Lawrence Rice and Rolando Vega and Cines, {Douglas B.} and Guevara, {James P.} and Adam Cuker",
year = "2019",
month = "11",
day = "1",
doi = "10.1111/jth.14587",
language = "English (US)",
volume = "17",
pages = "1956--1965",
journal = "Journal of Thrombosis and Haemostasis",
issn = "1538-7933",
publisher = "Wiley",
number = "11",

}

RIS

TY - JOUR

T1 - The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia

AU - Pishko, Allyson M.

AU - Lefler, Daniel S.

AU - Gimotty, Phyllis

AU - Paydary, Koosha

AU - Fardin, Sara

AU - Arepally, Gowthami M.

AU - Crowther, Mark

AU - Rice, Lawrence

AU - Vega, Rolando

AU - Cines, Douglas B.

AU - Guevara, James P.

AU - Cuker, Adam

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background: The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding. Objectives: To determine the incidence of major bleeding in patients with suspected HIT. Methods: We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT−) and exposure to an alternative anticoagulant (Tx+ or Tx−). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality. Results: The incidence of major bleeding was high in the HIT+Tx+, HIT− Tx+, and HIT−Tx− groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P =.24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44-3.47), platelet count < 25 × 109/L (HR 2.13, 1.10-4.12), and renal dysfunction (HR 1.56, 1.06-2.27); 35.7% of HIT+Tx+, 13.8% HIT−Tx+, and 9.3% of HIT−Tx− patients experienced new or progressive thrombosis. Mortality was similar among the three groups (26.2% HIT+Tx+, 34.5% HIT−Tx+, and 26.7% of HIT−Tx− [P =.34]). Conclusions: Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.

AB - Background: The presence of a hypercoagulable disorder such as heparin-induced thrombocytopenia (HIT) may protect against anticoagulant-associated bleeding. Objectives: To determine the incidence of major bleeding in patients with suspected HIT. Methods: We performed a retrospective analysis of 310 patients suspected of having HIT from the Hospital of the University of Pennsylvania and an affiliated community hospital. We compared the cumulative incidence of major bleeding following suspicion for HIT by ultimate HIT status (HIT+ or HIT−) and exposure to an alternative anticoagulant (Tx+ or Tx−). Secondary outcomes included the incidence of new/progressive thrombosis and 30-day mortality. Results: The incidence of major bleeding was high in the HIT+Tx+, HIT− Tx+, and HIT−Tx− groups (35.7%, 44.0%, and 37.3%, respectively). The time to first major bleeding event did not differ between groups (P =.24). Factors associated with increased risk of major bleeding included intensive care unit admission (HR 2.24, 95% CI 1.44-3.47), platelet count < 25 × 109/L (HR 2.13, 1.10-4.12), and renal dysfunction (HR 1.56, 1.06-2.27); 35.7% of HIT+Tx+, 13.8% HIT−Tx+, and 9.3% of HIT−Tx− patients experienced new or progressive thrombosis. Mortality was similar among the three groups (26.2% HIT+Tx+, 34.5% HIT−Tx+, and 26.7% of HIT−Tx− [P =.34]). Conclusions: Among patients with suspected HIT, major bleeding was common regardless of HIT status. Contrary to our hypothesis, HIT+ patients were not protected from major bleeding. A better understanding of bleeding risk is needed to inform management decisions in patients with suspected HIT.

KW - anticoagulants/adverse event

KW - anticoagulants/therapeutic use

KW - heparin/adverse event

KW - thrombocytopenia

KW - thrombosis

UR - http://www.scopus.com/inward/record.url?scp=85070705529&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070705529&partnerID=8YFLogxK

U2 - 10.1111/jth.14587

DO - 10.1111/jth.14587

M3 - Article

VL - 17

SP - 1956

EP - 1965

JO - Journal of Thrombosis and Haemostasis

T2 - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

SN - 1538-7933

IS - 11

ER -

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