TY - JOUR
T1 - Prospective multicentre cohort study of heparin-induced thrombocytopenia in acute ischaemic stroke patients
AU - Kawano, Hiroyuki
AU - Yamamoto, Haruko
AU - Miyata, Shigeki
AU - Izumi, Manabu
AU - Hirano, Teruyuki
AU - Toratani, Naomi
AU - Kakutani, Isami
AU - Sheppard, Jo Ann I.
AU - Warkentin, Theodore E.
AU - Kada, Akiko
AU - Sato, Shoichiro
AU - Okamoto, Sadahisa
AU - Nagatsuka, Kazuyuki
AU - Naritomi, Hiroaki
AU - Toyoda, Kazunori
AU - Uchino, Makoto
AU - Minematsu, Kazuo
PY - 2011/8
Y1 - 2011/8
N2 - Acute ischaemic stroke patients sometimes receive heparin for treatment and/or prophylaxis of thromboembolic complications. This study was designed to elucidate the incidence and clinical features of heparin-induced thrombocytopenia (HIT) in acute stroke patients treated with heparin. We conducted a prospective multicentre cohort study of 267 patients who were admitted to three stroke centres within 7d after stroke onset. We examined clinical data until discharge and collected blood samples on days1 and 14 of hospitalization to test anti-platelet factor 4/heparin antibodies (anti-PF4/H Abs) using an enzyme-linked immunosorbent assay (ELISA); platelet-activating antibodies were identified by serotonin-release assay (SRA). Patients with a 4Ts score ≥4points, positive-ELISA, and positive-SRA were diagnosed as definite HIT. Heparin was administered to 172 patients (64·4%: heparin group). Anti-PF4/H Abs were detected by ELISA in 22 cases (12·8%) in the heparin group. Seven patients had 4Ts≥4 points. Among them, three patients (1·7% overall) were also positive by both ELISA and SRA. National Institutes of Health Stroke Scale score on admission was high (range, 16-23) and in-hospital mortality was very high (66·7%) in definite HIT patients. In this study, the incidence of definite HIT in acute ischaemic stroke patients treated with heparin was 1·7% (95% confidence interval: 0·4-5·0). The clinical severity and outcome of definite HIT were unfavourable.
AB - Acute ischaemic stroke patients sometimes receive heparin for treatment and/or prophylaxis of thromboembolic complications. This study was designed to elucidate the incidence and clinical features of heparin-induced thrombocytopenia (HIT) in acute stroke patients treated with heparin. We conducted a prospective multicentre cohort study of 267 patients who were admitted to three stroke centres within 7d after stroke onset. We examined clinical data until discharge and collected blood samples on days1 and 14 of hospitalization to test anti-platelet factor 4/heparin antibodies (anti-PF4/H Abs) using an enzyme-linked immunosorbent assay (ELISA); platelet-activating antibodies were identified by serotonin-release assay (SRA). Patients with a 4Ts score ≥4points, positive-ELISA, and positive-SRA were diagnosed as definite HIT. Heparin was administered to 172 patients (64·4%: heparin group). Anti-PF4/H Abs were detected by ELISA in 22 cases (12·8%) in the heparin group. Seven patients had 4Ts≥4 points. Among them, three patients (1·7% overall) were also positive by both ELISA and SRA. National Institutes of Health Stroke Scale score on admission was high (range, 16-23) and in-hospital mortality was very high (66·7%) in definite HIT patients. In this study, the incidence of definite HIT in acute ischaemic stroke patients treated with heparin was 1·7% (95% confidence interval: 0·4-5·0). The clinical severity and outcome of definite HIT were unfavourable.
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U2 - 10.1111/j.1365-2141.2011.08775.x
DO - 10.1111/j.1365-2141.2011.08775.x
M3 - Article
C2 - 21671895
AN - SCOPUS:79960209027
SN - 0007-1048
VL - 154
SP - 378
EP - 386
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 3
ER -