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Suspicion of heparin-induced thrombocytopenia in internal medicine: How appropriate is the ordering of anti-PF4/heparin antibody testing?
[heparin-induced thrombocytopenia]
Abstract
Thrombocytopenia
is
frequent
in
hospitalized
patients
,
and
heparin-induced
thrombocytopenia
(
HIT
)
is
often
suspected
when
a
decrease
in
platelet
count
is
concomitant
with
heparin
treatment
.
ELISA
tests
used
for
anti-
PF
4
/
heparin
antibodies
detection
usually
have
high
sensitivity
but
only
fair
specificity
for
HIT
.
Pre-test
probability
scores
(
such
as
4
Ts
or
HEP
scores
)
have
been
validated
and
a
low
probability
score
rules
out
HIT
without
anti-
PF
4
/
heparin
testing
.
The
aims
of
this
study
are
to
evaluate
the
appropriateness
of
anti-
PF
4
/
heparin
testing
according
to
pre-test
probabilities
of
HIT
and
to
compare
the
abilities
of
the
4
Ts
and
HEP
scores
to
avoid
inappropriate
anti-
PF
4
/
heparin
testing
.
This
retrospective
observational
study
included
74
consecutive
patients
hospitalized
in
a
general
internal
medicine
division
who
had
anti-
PF
4
/
heparin
testing
for
suspicion
of
HIT
.
4
Ts
and
HEP
scores
were
computed
retrospectively
.
About
73
%
of
patients
who
had
ordering
of
an
anti-
PF
4
/
heparin
were
at
low
risk
according
to
the
4
Ts
score
,
and
46
%
according
to
the
HEP
score
.
Heparin
was
discontinued
in
61
%
and
62
%
of
low
-risk
patients
according
to
4
Ts
and
HEP
scores
and
switched
to
alternative
anticoagulant
in
31
%
and
32
%
of
them
,
respectively
.
No
case
of
HIT
was
diagnosed
in
patients
with
a
low
-risk
score
.
One
major
bleeding
and
no
thrombosis
were
observed
.
For
the
4
Ts
score
,
the
sensitivity
was
100
%
,
the
negative
predictive
value
(
NPV
)
was
100
%
,
the
specificity
was
77
%
,
and
the
positive
predictive
value
(
PPV
)
was
20
%
(
95
%
CI
:
7
-
44
)
.
For
the
HEP
score
,
the
sensitivity
was
100
%
,
the
NPV
was
100
%
,
the
specificity
was
49
%
,
and
the
PPV
was
10
%
.
In
conclusion
,
pre-test
probability
scores
were
vastly
underused
in
this
internal
medicine
population
despite
their
ability
to
rule
out
HIT
without
laboratory
testing
in
a
large
proportion
of
patients
.
Appropriate
use
of
those
instruments
should
be
actively
promoted
.
Diseases
Validation
Diseases presenting
"high sensitivity"
symptom
adrenal incidentaloma
alpha-thalassemia
familial mediterranean fever
heparin-induced thrombocytopenia
hodgkin lymphoma, classical
holt-oram syndrome
inclusion body myositis
legionellosis
locked-in syndrome
phenylketonuria
pyomyositis
pyruvate dehydrogenase deficiency
sneddon syndrome
werner syndrome
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