Accuracy of heparin-induced platelet aggregation test for the diagnosis of heparin-induced thrombocytopenia.

Brodard, Justine; Alberio, Lorenzo; Angelillo-Scherrer, Anne; Nagler, Michael (2020). Accuracy of heparin-induced platelet aggregation test for the diagnosis of heparin-induced thrombocytopenia. Thrombosis research, 185, pp. 27-30. Elsevier 10.1016/j.thromres.2019.11.004

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INTRODUCTION

Whereas the utility of washed platelet assays such as the heparin-induced platelet activation test (HIPA) for the diagnosis of heparin-induced thrombocytopenia (HIT) is regarded as high, the performance of simpler assays such as the heparin-induced platelet aggregation test (PAT) is still elusive. Using well-characterized samples of a large cohort study, we aimed to assess the diagnostic accuracy of PAT for the diagnosis of HIT.

MATERIAL AND METHODS

One-hundred twenty-two immunoassay-positive serum samples of a previous, prospective single-center cohort study including consecutive patients with suspected HIT (n = 1291) were used. HIPA was determined as reference gold standard; samples were previously analyzed using PAT as well as polyspecific platelet factor 4/heparin enzyme-linked immunosorbent assay (ELISA). 4Ts score was calculated using the patient documentation. Diagnosis of HIT was defined as a positive HIPA, which is a positive reaction in 2 out of 4 donor platelets within 30 min.

RESULTS

HIT was diagnosed in 39 out of 122 patients corresponding to a prevalence of 32%. Median optical density (ELISA) was 2.8 (inter-quartile range 2.3, 3.0) in patients with HIT and 0.7 (0.5, 1.3) in patients without HIT. PAT was positive in 27 out of 39 HIT patients and it was negative in 83 out of 83 HIT-negative patients. Thus, the sensitivity of PAT for the diagnosis of HIT was 69% (95% confidence interval 52%, 83%) and the specificity 100% (96%, 100%).

CONCLUSIONS

Our results demonstrate that PAT is a valuable test to confirm HIT but cannot be applied to rule-out HIT in clinical practice.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Hämatologie (Erwachsene)

UniBE Contributor:

 Brodard, Justine, Angelillo, Anne, Nagler, Michael

Subjects:

 600 Technology > 610 Medicine & health

ISSN:

 0049-3848

Publisher:

 Elsevier

Language:

 English

Submitter:

 Pierrette Durand Lüthi

Date Deposited:

 10 Dec 2019 10:28

Last Modified:

 05 Dec 2022 15:32

Publisher DOI:

 10.1016/j.thromres.2019.11.004

PubMed ID:

 31739198

Uncontrolled Keywords:

 Heparin-induced thrombocytopenia Heparin/adverse effects Immunoassay/methods Thrombocytopenia/chemically induced Thrombocytopenia/diagnosis

BORIS DOI:

 10.7892/boris.135431

URI:

 https://boris.unibe.ch/id/eprint/135431

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