Higher optical density of an antigen assay predicts thrombosis in patients with heparin-induced thrombocytopenia

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Abstract

Objectives: To correlate optical density and percent inhibition of a two-step heparin-induced thrombocytopenia (HIT) antigen assay with thrombosis; the assay utilizes reaction inhibition characteristics of a high heparin concentration. Patients and Methods: Patients with more than 50% decrease in platelet count or thrombocytopenia (<150 × 109/L) after exposure to heparin, who had a positive two-step antigen assay [optical density (OD) >0.4 and >50 inhibition with high concentration of heparin] were included in the study. Results: Forty of 94 HIT patients had thrombosis at diagnosis; 54/94 had isolated-HIT without thrombosis. Eight of the isolated-HIT patients developed thrombosis within the next 30 d; thus, a total of 48 patients had thrombosis at day 30. At diagnosis there was no significant difference in OD between HIT patients with thrombosis and those with isolated-HIT. However, OD was significantly higher in all patients with thrombosis (n = 48, 1.34 ± 0.89), including isolated-HIT patients who later developed thrombosis within 30 d (n = 8, 1.84 ± 0.64) as compared to isolated-HIT patients who did not develop thrombosis (0.96 ± 0.75; P = 0.011 and P = 0.008). The Receiver Operative Characteristic Curve showed that OD >1.27 in the isolated-HIT group had a significantly higher chance of developing thrombosis by day 30. None of these groups showed significant difference in percent inhibition. Multivariate analysis showed a 2.8-fold increased risk of thrombosis in females. Similarly, thrombotic risk increased with age and OD values. Conclusion: Higher OD is associated with significant risk of subsequent thrombosis in patients with isolated-HIT; percent inhibition, however, was not predictive.

Original languageEnglish (US)
Pages (from-to)429-435
Number of pages7
JournalEuropean Journal of Haematology
Volume80
Issue number5
DOIs
StatePublished - May 2008

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Thrombocytopenia
Heparin
Thrombosis
Antigens
Platelet Count
Multivariate Analysis

Keywords

  • Enzyme-linked immunosorbent assay
  • Heparin-induced thrombocytopenia
  • Risk factors
  • Thrombosis

ASJC Scopus subject areas

  • Hematology

Cite this

@article{8819fc53d57c4e31836749a9a9cadf06,
title = "Higher optical density of an antigen assay predicts thrombosis in patients with heparin-induced thrombocytopenia",
abstract = "Objectives: To correlate optical density and percent inhibition of a two-step heparin-induced thrombocytopenia (HIT) antigen assay with thrombosis; the assay utilizes reaction inhibition characteristics of a high heparin concentration. Patients and Methods: Patients with more than 50{\%} decrease in platelet count or thrombocytopenia (<150 × 109/L) after exposure to heparin, who had a positive two-step antigen assay [optical density (OD) >0.4 and >50 inhibition with high concentration of heparin] were included in the study. Results: Forty of 94 HIT patients had thrombosis at diagnosis; 54/94 had isolated-HIT without thrombosis. Eight of the isolated-HIT patients developed thrombosis within the next 30 d; thus, a total of 48 patients had thrombosis at day 30. At diagnosis there was no significant difference in OD between HIT patients with thrombosis and those with isolated-HIT. However, OD was significantly higher in all patients with thrombosis (n = 48, 1.34 ± 0.89), including isolated-HIT patients who later developed thrombosis within 30 d (n = 8, 1.84 ± 0.64) as compared to isolated-HIT patients who did not develop thrombosis (0.96 ± 0.75; P = 0.011 and P = 0.008). The Receiver Operative Characteristic Curve showed that OD >1.27 in the isolated-HIT group had a significantly higher chance of developing thrombosis by day 30. None of these groups showed significant difference in percent inhibition. Multivariate analysis showed a 2.8-fold increased risk of thrombosis in females. Similarly, thrombotic risk increased with age and OD values. Conclusion: Higher OD is associated with significant risk of subsequent thrombosis in patients with isolated-HIT; percent inhibition, however, was not predictive.",
keywords = "Enzyme-linked immunosorbent assay, Heparin-induced thrombocytopenia, Risk factors, Thrombosis",
author = "Fevzi Altuntas and Karen Matevosyan and James Burner and Shen, {Yu Min} and Ravindra Sarode",
year = "2008",
month = "5",
doi = "10.1111/j.1600-0609.2008.01035.x",
language = "English (US)",
volume = "80",
pages = "429--435",
journal = "European Journal of Haematology",
issn = "0902-4441",
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TY - JOUR

T1 - Higher optical density of an antigen assay predicts thrombosis in patients with heparin-induced thrombocytopenia

AU - Altuntas, Fevzi

AU - Matevosyan, Karen

AU - Burner, James

AU - Shen, Yu Min

AU - Sarode, Ravindra

PY - 2008/5

Y1 - 2008/5

N2 - Objectives: To correlate optical density and percent inhibition of a two-step heparin-induced thrombocytopenia (HIT) antigen assay with thrombosis; the assay utilizes reaction inhibition characteristics of a high heparin concentration. Patients and Methods: Patients with more than 50% decrease in platelet count or thrombocytopenia (<150 × 109/L) after exposure to heparin, who had a positive two-step antigen assay [optical density (OD) >0.4 and >50 inhibition with high concentration of heparin] were included in the study. Results: Forty of 94 HIT patients had thrombosis at diagnosis; 54/94 had isolated-HIT without thrombosis. Eight of the isolated-HIT patients developed thrombosis within the next 30 d; thus, a total of 48 patients had thrombosis at day 30. At diagnosis there was no significant difference in OD between HIT patients with thrombosis and those with isolated-HIT. However, OD was significantly higher in all patients with thrombosis (n = 48, 1.34 ± 0.89), including isolated-HIT patients who later developed thrombosis within 30 d (n = 8, 1.84 ± 0.64) as compared to isolated-HIT patients who did not develop thrombosis (0.96 ± 0.75; P = 0.011 and P = 0.008). The Receiver Operative Characteristic Curve showed that OD >1.27 in the isolated-HIT group had a significantly higher chance of developing thrombosis by day 30. None of these groups showed significant difference in percent inhibition. Multivariate analysis showed a 2.8-fold increased risk of thrombosis in females. Similarly, thrombotic risk increased with age and OD values. Conclusion: Higher OD is associated with significant risk of subsequent thrombosis in patients with isolated-HIT; percent inhibition, however, was not predictive.

AB - Objectives: To correlate optical density and percent inhibition of a two-step heparin-induced thrombocytopenia (HIT) antigen assay with thrombosis; the assay utilizes reaction inhibition characteristics of a high heparin concentration. Patients and Methods: Patients with more than 50% decrease in platelet count or thrombocytopenia (<150 × 109/L) after exposure to heparin, who had a positive two-step antigen assay [optical density (OD) >0.4 and >50 inhibition with high concentration of heparin] were included in the study. Results: Forty of 94 HIT patients had thrombosis at diagnosis; 54/94 had isolated-HIT without thrombosis. Eight of the isolated-HIT patients developed thrombosis within the next 30 d; thus, a total of 48 patients had thrombosis at day 30. At diagnosis there was no significant difference in OD between HIT patients with thrombosis and those with isolated-HIT. However, OD was significantly higher in all patients with thrombosis (n = 48, 1.34 ± 0.89), including isolated-HIT patients who later developed thrombosis within 30 d (n = 8, 1.84 ± 0.64) as compared to isolated-HIT patients who did not develop thrombosis (0.96 ± 0.75; P = 0.011 and P = 0.008). The Receiver Operative Characteristic Curve showed that OD >1.27 in the isolated-HIT group had a significantly higher chance of developing thrombosis by day 30. None of these groups showed significant difference in percent inhibition. Multivariate analysis showed a 2.8-fold increased risk of thrombosis in females. Similarly, thrombotic risk increased with age and OD values. Conclusion: Higher OD is associated with significant risk of subsequent thrombosis in patients with isolated-HIT; percent inhibition, however, was not predictive.

KW - Enzyme-linked immunosorbent assay

KW - Heparin-induced thrombocytopenia

KW - Risk factors

KW - Thrombosis

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U2 - 10.1111/j.1600-0609.2008.01035.x

DO - 10.1111/j.1600-0609.2008.01035.x

M3 - Article

C2 - 18208574

AN - SCOPUS:41849090415

VL - 80

SP - 429

EP - 435

JO - European Journal of Haematology

JF - European Journal of Haematology

SN - 0902-4441

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