Department of Pharmacy, The Methodist Hospital, Houston, TX 77030,
Clin Appl Thromb Hemost. 2013 Jun;19(3):297-302. doi: 10.1177/1076029612438709. Epub 2012 Mar 2.
The diagnosis of heparin-induced thrombocytopenia (HIT) may be challenging in critically ill patients, as heparin exposures are ubiquitous, and thrombocytopenia is common. Unwarranted ordering and incorrect interpretation of heparin antibody tests can expose a patient to adverse drug events and imposes a significant economic burden on our health care system.
A prospective, observational study was performed over 4 months on all adult patients located in 5 intensive care units, with a heparin antibody test ordered.
A platelet factor 4/heparin enzyme-linked immunosorbent assay (ELISA) test was ordered in 131 patients. In total, 110 patients had a low 4Ts score (0-3), and of these 103 had a negative ELISA result. In patients with a low 4Ts score, 0 (0%) of 110 had an optical density value >1.0. One hundred twenty-nine patients (98%) had another possible cause of thrombocytopenia identified.
In critically ill patients, low 4Ts scores indicate a low probability of HIT, and heparin antibody testing in these patients is not useful.
在危重病患者中，肝素诱导的血小板减少症（HIT）的诊断可能具有挑战性，因为肝素暴露普遍存在，且血小板减少症也很常见。肝素抗体检测的不必要的开具和不正确的解读可能会使患者面临药物不良事件，并给我们的医疗系统带来巨大的经济负担。
在 4 个月的时间里，对位于 5 个重症监护病房的所有成年患者进行了一项前瞻性、观察性研究，这些患者都开具了肝素抗体检测。
在 131 名患者中，共进行了血小板因子 4/肝素酶联免疫吸附试验（ELISA）检测。总的来说，110 名患者的 4Ts 评分较低（0-3），其中 103 名患者的 ELISA 结果为阴性。在 4Ts 评分较低的患者中，110 名患者的吸光度值均<1.0，无一例>1.0。129 名患者（98%）确定了其他可能导致血小板减少的原因。
在危重病患者中，4Ts 评分较低提示 HIT 的可能性较低，因此对这些患者进行肝素抗体检测并无用处。
