Pathak Ranjan, Bhatt Vijaya Raj, Karmacharya Paras, Aryal Madan Raj, Donato Anthony A
Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NB, USA.
J Hosp Med. 2017 Feb;12(2):94-97. doi: 10.12788/jhm.2687.
In recent years, US hospitals have switched from use of unfractionated heparin to use of low-molecular-weight heparin, which is associated with lower risk of heparin-induced thrombocytopenia (HIT). In the study reported here, we retrospectively searched the Nationwide Inpatient Sample (NIS) for patients who were at least 18 years old and received a diagnosis of HIT between 2009 and 2011. Our goal was to get an updated perspective on the incidence and economic impact of HIT. We calculated the incidence of HIT overall and in subgroups of patients who underwent cardiac, vascular, or orthopedic surgery. We compared characteristics of patients with and without HIT and compared characteristics of patients with HIT with thrombosis (HITT) and HIT patients without thrombosis. Of 98,636,364 hospitalizations, 72,515 (0.07%) involved HIT. Arterial and venous thromboses were identified in 24,880 (34.3%) of HIT cases. Men were slightly more likely to have a HIT diagnosis (50.1%), but women had higher rates of HIT after cardiac surgery (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.26-1.58) and vascular surgery (OR, 1.42; 95% CI, 1.29-1.57). Rates of HIT were 0.53% (95% CI, 0.51%-0.54%) after cardiac surgery, 0.28% (95% CI, 0.28%-0.29%) after vascular surgery, and 0.05% (95% CI, 0.05%-0.06%) after orthopedic surgery. HIT and HITT cases were significantly (P ⟨ 0.001) more likely than non-HIT cases to be fatal (9.63% and 12.28% vs 2.19%), and they had significantly higher costs and longer inpatient stays. HIT and especially HITT are associated with increased mortality, costs, and length of stay. Journal of Hospital Medicine 2017;12:94-97.
近年来，美国医院已从不使用普通肝素转而使用低分子量肝素，后者与肝素诱导的血小板减少症（HIT）风险较低相关。在本文报道的研究中，我们对全国住院患者样本（NIS）进行了回顾性检索，以查找2009年至2011年间至少18岁且被诊断为HIT的患者。我们的目标是获取关于HIT发病率和经济影响的最新观点。我们计算了总体HIT发病率以及接受心脏、血管或骨科手术患者亚组中的发病率。我们比较了有HIT和无HIT患者的特征，并比较了有血栓形成的HIT患者（HITT）和无血栓形成的HIT患者的特征。在98,636,364次住院治疗中，72,515例（0.07%）涉及HIT。在24,880例（34.3%）HIT病例中发现了动脉和静脉血栓形成。男性被诊断为HIT的可能性略高（50.1%），但女性在心脏手术后HIT发生率更高（优势比[OR]为1.41；95%置信区间[CI]为1.26 - 1.58），在血管手术后也是如此（OR为1.42；95%CI为1.29 - 1.57）。心脏手术后HIT发生率为0.53%（95%CI为0.51% - 0.54%），血管手术后为0.28%（95%CI为0.28% - 0.29%），骨科手术后为0.05%（95%CI为0.05% - 0.06%）。与非HIT病例相比，HIT和HITT病例的死亡可能性显著更高（P⟨0.001）（分别为9.63%和12.28%，而非2.19%），并且它们的费用显著更高，住院时间更长。HIT尤其是HITT与死亡率增加、费用增加和住院时间延长相关。《医院医学杂志》2017年；12：94 - 97。
