Mehta Brijesh P, Sims John R, Baccin Carlos E, Leslie-Mazwi Thabele M, Ogilvy Christopher S, Nogueira Raul G
Department of Neurology, Harvard Medical School, Boston, Mass., USA ; Department of Radiology, Harvard Medical School, Boston, Mass., USA.
Department of Neurology, Harvard Medical School, Boston, Mass., USA.
Interv Neurol. 2014 Aug;2(4):160-8. doi: 10.1159/000362189.
Heparin-induced thrombocytopenia (HIT) is a dreaded complication of heparin-related products and correlates with a worse outcome in aneurysmal subarachnoid hemorrhage (SAH) patients.
To study the risk factors and outcomes of SAH patients suspected of having HIT, confirmed as present or absent by the platelet factor 4 (PF4) antibody test.
All patients with presumed aneurysmal, nontraumatic SAH and having undergone a PF4 test were identified through our research patient database. Charts, laboratory values and images were analyzed retrospectively.
We identified 166 patients with SAH who were tested for HIT; 42 patients (25%) had a positive antibody test. There was no difference in platelet profiles or mean platelet nadirs of HIT+ and HIT- patients (147 ± 93 vs. 153 ± 86 ×10(9)/l, respectively). Univariate analysis identified gender, magnesium prophylaxis, Fisher group 3, clipping versus coiling, presence of angiographic vasospasm, number of vasospasm treatments, and day of HIT testing as potential risk factors associated with HIT. A multivariate analysis indicated that female gender (OR 8.2, 95% CI 2.0-33.2), greater number of vasospasm treatments (OR 1.5, 95% CI 1.2-2.0), later day of HIT testing (OR 1.2, 95% CI 1.1-1.3), and clipping (OR 5.0, 95% CI 1.42-10.0) were independently associated with HIT positivity. HIT+ patients showed more infarcts on CT, longer ICU and hospital stays and worse modified Rankin Scale scores on discharge.
The presence of HIT in SAH has adverse consequences and is more likely in female patients who have undergone aneurysm clipping and require multiple endovascular vasospasm treatments.
肝素诱导的血小板减少症（HIT）是肝素相关产品令人恐惧的并发症，与动脉瘤性蛛网膜下腔出血（SAH）患者的不良预后相关。
研究疑似患有HIT的SAH患者的危险因素及预后情况，通过血小板因子4（PF4）抗体检测确诊其是否存在HIT。
通过我们的研究患者数据库识别所有疑似动脉瘤性、非创伤性SAH且接受了PF4检测的患者。对病历、实验室检查值和影像进行回顾性分析。
我们确定了166例接受HIT检测的SAH患者；42例患者（25%）抗体检测呈阳性。HIT阳性和阴性患者的血小板参数或平均血小板最低点无差异（分别为147±93与153±86×10⁹/L）。单因素分析确定性别、镁预防、Fisher 3级、夹闭与栓塞、血管造影血管痉挛的存在、血管痉挛治疗次数以及HIT检测日期为与HIT相关的潜在危险因素。多因素分析表明，女性（比值比8.2，95%置信区间2.0 - 33.2）、血管痉挛治疗次数较多（比值比1.5，95%置信区间1.2 - 2.0）、HIT检测日期较晚（比值比1.2，95%置信区间1.1 - 1.3）以及夹闭（比值比5.0，95%置信区间1.42 - 10.0）与HIT阳性独立相关。HIT阳性患者CT上梗死灶更多，重症监护病房（ICU）和住院时间更长，出院时改良Rankin量表评分更差。
SAH患者中HIT的存在具有不良后果，在接受动脉瘤夹闭且需要多次血管内血管痉挛治疗的女性患者中更常见。
