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Heparin-induced thrombocytopenia testing is over-utilized in cirrhosis & correlates with poor clinical outcomes.
[heparin-induced thrombocytopenia]
Heparin-induced
thrombocytopenia
(
HIT
)
is
a
serious
complication
seen
in
hospitalized
,
medically-ill
patients
.
Evaluation
for
HIT
using
a
commercially-available
ELISA
-based
test
has
become
increasingly
common
;
however
,
it
does
have
a
high
false
positive
rate
.
Implications
of
HIT
testing
in
patients
with
cirrhosis
have
not
yet
been
reported
.
We
conducted
a
single
-institution
,
retrospective
review
of
all
patients
with
cirrhosis
admitted
over
a
29
-
month
period
.
The
student
's
t-test
and
the
χ
2
test
were
used
for
comparisons
.
We
performed
a
stratified
survival
analysis
using
Kaplan-
Meier
and
log
rank
testing
.
A
total
of
1
,
305
patients
had
a
HIT
Ab
sent
during
the
study
period
.
Of
these
patients
,
106
had
cirrhosis
and
were
included
in
the
study
.
Eighteen
(
17
%
)
of
the
patients
with
cirrhosis
were
HIT
Ab
positive
and
four
of
the
eighteen
had
a
positive
Serotonin
Release
Assay
(
SRA
)
confirmatory
test
.
No
difference
was
found
in
platelet
nadir
,
thrombotic
rate
,
length
of
stay
,
and
patient
survival
between
patients
with
positive
HIT
Ab
and
negative
HIT
Ab
testing
.
No
consistent
treatment
was
used
among
patients
who
were
HIT
Ab
positive
,
despite
hematology
service
consultation
.
Patients
who
were
HIT
Ab
negative
were
more
likely
to
have
undergone
liver
transplantation
compared
to
those
who
were
positive
(
27
vs
.
5
.
5
%
,
respectively
;
p
=
0
.
048
)
.
Our
data
suggest
that
HIT
Ab
testing
is
over-used
in
patients
with
cirrhosis
and
is
poorly
predictive
of
outcomes
.
With
a
poor
positive
predictive
value
,
HIT
testing
may
add
unnecessary
complexity
to
an
already
complicated
patient
population
.
Diseases
Validation
Diseases presenting
"is poorly predictive of outcomes"
symptom
heparin-induced thrombocytopenia
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