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Predictors and outcomes of suspected heparin-induced thrombocytopenia in subarachnoid hemorrhage patients.
[heparin-induced thrombocytopenia]
Heparin-induced
thrombocytopenia
(
HIT
)
is
a
dreaded
complication
of
heparin-related
products
and
correlates
with
a
worse
outcome
in
aneurysmal
subarachnoid
hemorrhage
(
SAH
)
patients
.
To
study
the
risk
factors
and
outcomes
of
SAH
patients
suspected
of
having
HIT
,
confirmed
as
present
or
absent
by
the
platelet
factor
4
(
PF
4
)
antibody
test
.
All
patients
with
presumed
aneurysmal
,
nontraumatic
SAH
and
having
undergone
a
PF
4
test
were
identified
through
our
research
patient
database
.
Charts
,
laboratory
values
and
images
were
analyzed
retrospectively
.
We
identified
166
patients
with
SAH
who
were
tested
for
HIT
;
42
patients
(
25
%
)
had
a
positive
antibody
test
.
There
was
no
difference
in
platelet
profiles
or
mean
platelet
nadirs
of
HIT
+
and
HIT
-
patients
(
147
±
93
vs
.
153
±
86
×
10
(
9
)
/
l
,
respectively
)
.
Univariate
analysis
identified
gender
,
magnesium
prophylaxis
,
Fisher
group
3
,
clipping
versus
coiling
,
presence
of
angiographic
vasospasm
,
number
of
vasospasm
treatments
,
and
day
of
HIT
testing
as
potential
risk
factors
associated
with
HIT
.
A
multivariate
analysis
indicated
that
female
gender
(
OR
8
.
2
,
95
%
CI
2
.
0
-
33
.
2
)
,
greater
number
of
vasospasm
treatments
(
OR
1
.
5
,
95
%
CI
1
.
2
-
2
.
0
)
,
later
day
of
HIT
testing
(
OR
1
.
2
,
95
%
CI
1
.
1
-
1
.
3
)
,
and
clipping
(
OR
5
.
0
,
95
%
CI
1
.
42
-
10
.
0
)
were
independently
associated
with
HIT
positivity
.
HIT
+
patients
showed
more
infarcts
on
CT
,
longer
ICU
and
hospital
stays
and
worse
modified
Rankin
Scale
scores
on
discharge
.
The
presence
of
HIT
in
SAH
has
adverse
consequences
and
is
more
likely
in
female
patients
who
have
undergone
aneurysm
clipping
and
require
multiple
endovascular
vasospasm
treatments
.
Diseases
Validation
Diseases presenting
"multiple endovascular vasospasm treatments"
symptom
heparin-induced thrombocytopenia
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