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Prepublished online as a Blood First Edition Paper on December 12, 2002; DOI 10.1182/blood-2002-07-2201.
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Blood, 15 April 2003, Vol. 101, No. 8, pp. 2955-2959
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
The incidence of heparin-induced thrombocytopenia in
hospitalized medical patients treated with subcutaneous
unfractionated heparin: a prospective cohort study
Bruno Girolami,
Paolo Prandoni,
Piero M. Stefani,
Cinzia Tanduo,
Paola Sabbion,
Petra Eichler,
Roberto Ramon,
Giovannella Baggio,
Fabrizio Fabris, and
Antonio Girolami
From the Division of Internal Medicine, Department of
Medical and Surgical Sciences, 2nd Chair of Internal Medicine,
University Hospital of Padua, Italy; and Institute for Immunology and
Transfusion Medicine, Ernst-Moritz-Arndt University, Greifswald,
Germany.
Although heparin-induced thrombocytopenia (HIT) is a known
complication of intravenous unfractionated heparin (UFH), its incidence in medical patients treated with subcutaneous UFH is less well defined.
To determine the incidence of HIT in this category of patients, the
platelet count was performed at baseline and then every 3 ± 1 days
in 598 consecutive patients admitted to 2 medical wards and treated
with subcutaneous UFH for prophylactic (n = 360) or therapeutic
(n = 238) indications. The diagnosis of HIT was accepted in the case
of a platelet drop of 50% or more and either the demonstration of
heparin-dependent antibodies or (when this search could not be
performed) the combination of the following features: (1) the absence
of any other obvious clinical explanation for thrombocytopenia, (2) the
occurrence of thrombocytopenia at least 5 days after heparin start, and
(3) either the normalization of the platelet count within 10 days after
heparin discontinuation or the earlier patient's death due to an
unexpected thromboembolic complication. HIT developed in 5 patients
(0.8%; 95% CI, 0.1%-1.6%); all of them belonged to the subgroup of
patients who received heparin for prophylactic indications. The
prevalence of thromboembolic complications in patients with HIT (60%)
was remarkably higher than that observed in the remaining 593 patients
(3.5%), leading to an odds ratio of 40.8 (95% CI, 5.2-162.8).
Although the frequency of HIT in hospitalized medical patients treated
with subcutaneous heparin is lower than that observed in other clinical
settings, this complication is associated with a similarly high rate of thromboembolic events.
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