An Institutional Report of Heparin Induced Thrombocytopenia Type II in Aneurysmal Subarachnoid Hemorrhage Patients
Student, Resident/Fellow, Faculty
BACKGROUND: Heparin induced thrombocytopenia Type II (HIT-II) is a dangerous thromboembolic complication of heparin therapy. The current literature on incidence and outcomes of HIT-II in aneurysmal subarachnoid hemorrhage (aSAH) patients remains sparse. OBJECTIVE: We report our institution's incidence and outcomes of HIT-II in aSAH patients. METHODS: We performed a retrospective cohort study at an academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography. Diagnosis of HIT-II was determined by positive results on both heparin PF4-platelet antibody ELISA (anti-PF4) and serotonin release assay (SRA). RESULTS: 204 patients met inclusion criteria. Seven patients (7/204, 3.5%) underwent laboratory testing, three of whom met clinical criteria. HIT-II incidence was confirmed in two of these seven patients (2/204, 0.98%), who had high BMI and T4 scores. CONCLUSION: Our institution's report of HIT-II incidence in aSAH patients is lower than previously reported in this population and more closely parallels HIT-II incidence in the general and surgical ICU setting. Widely-accepted American College of Chest Physicians (ACCP) clinical diagnostic criteria in conjunction with anti-PF4 and SRA testing is the gold standard of clinical diagnosis of HIT-II in aSAH patients.
Li, B., Sursal, T., Martinez, E., Karimov, Z., Feldstein, E., Stein, A., Cooper, J., Hosein-Woodley, R., Liu, A., McIntyre, M., Bowers, C., Hanft, S., Hafeez, Z., Pisapia, J., Muh, C., Tyagi, R., Mayer, S. A., Gandhi, C. D., & Al-Mufti, F. (2023). An Institutional Report of Heparin Induced Thrombocytopenia Type II in Aneurysmal Subarachnoid Hemorrhage Patients. https://doi.org/10.1177/15910199221091643