Assessment of the performances of AcuStar HIT and the combination with heparin-induced multiple electrode aggregometry: A retrospective study

V. Minet, N. Bailly, J. Douxfils, J. C. Osselaer, J. Laloy, C. Chatelain, I. Elalamy, B. Chatelain, J. M. Dogné, F. Mullier

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Abstract

Background Early diagnosis of immune heparin-induced thrombocytopenia (HIT) is challenging. HemosIL® AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) were recently proposed as rapid diagnostic methods. Objectives We conducted a study to assess performances of AcuStar HIT-IgG (PF4-H) and AcuStar HIT-Ab (PF4-H). The secondary objective was to compare the performances of the combination of Acustar HIT and HIMEA with standardised clinical diagnosis. Methods Sera of 104 suspected HIT patients were retrospectively tested with AcuStar HIT. HIMEA was performed on available sera (n = 81). The clinical diagnosis was established by analysing in a standardized manner the patient's medical records. These tests were also compared with PF4-Enhanced®, LTA, and SRA in subsets of patients. Thresholds were determined using ROC curve analysis with clinical outcome as reference. Results Using the recommended thresholds (1.00 AU), the negative predictive value (NPV) of HIT-IgG and HIT-Ab were 100.0% (95% CI: 95.9%-100.0% and 95.7%-100.0%). The positive predictive value (PPV) were 64.3% (95% CI: 35.1%-87.2.2%) and 45.0% (95% CI: 23.2%-68.6%), respectively. Using our thresholds (HIT-IgG: 2.89 AU, HIT-Ab: 9.41 AU), NPV of HIT-IgG and HIT-Ab were 100.0% (95% CI: 96.0%-100.0% and 96.1%-100.0%). PPV were 75.0% (95% CI: 42.7%-94.5%) and 81.8% (95% CI: 48.3%-97.7%), respectively. Of the 79 patients with a medium-high pretest probability score, 67 were negative using HIT-IgG (PF4-H) test at our thresholds. HIMEA was performed on HIT-IgG positive patients. Using this combination, only one patient on 79 was incorrectly diagnosed. Conclusion Acustar HIT showed good performances to exclude the diagnosis of HIT. Combination with HIMEA improves PPV.

Original languageEnglish
Pages (from-to)352-359
Number of pages8
JournalThrombosis Research
Volume132
Issue number3
DOIs
Publication statusPublished - 1 Sep 2013

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Thrombocytopenia
Heparin
Electrodes
Retrospective Studies
Immunoglobulin G
ROC Curve

Keywords

  • Heparin-induced thrombocytopenia
  • Immunoassay
  • Platelets

Cite this

@article{ba37077d10d945b9a187c7a1b831985c,
title = "Assessment of the performances of AcuStar HIT and the combination with heparin-induced multiple electrode aggregometry: A retrospective study",
abstract = "Background Early diagnosis of immune heparin-induced thrombocytopenia (HIT) is challenging. HemosIL{\circledR} AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) were recently proposed as rapid diagnostic methods. Objectives We conducted a study to assess performances of AcuStar HIT-IgG (PF4-H) and AcuStar HIT-Ab (PF4-H). The secondary objective was to compare the performances of the combination of Acustar HIT and HIMEA with standardised clinical diagnosis. Methods Sera of 104 suspected HIT patients were retrospectively tested with AcuStar HIT. HIMEA was performed on available sera (n = 81). The clinical diagnosis was established by analysing in a standardized manner the patient's medical records. These tests were also compared with PF4-Enhanced{\circledR}, LTA, and SRA in subsets of patients. Thresholds were determined using ROC curve analysis with clinical outcome as reference. Results Using the recommended thresholds (1.00 AU), the negative predictive value (NPV) of HIT-IgG and HIT-Ab were 100.0{\%} (95{\%} CI: 95.9{\%}-100.0{\%} and 95.7{\%}-100.0{\%}). The positive predictive value (PPV) were 64.3{\%} (95{\%} CI: 35.1{\%}-87.2.2{\%}) and 45.0{\%} (95{\%} CI: 23.2{\%}-68.6{\%}), respectively. Using our thresholds (HIT-IgG: 2.89 AU, HIT-Ab: 9.41 AU), NPV of HIT-IgG and HIT-Ab were 100.0{\%} (95{\%} CI: 96.0{\%}-100.0{\%} and 96.1{\%}-100.0{\%}). PPV were 75.0{\%} (95{\%} CI: 42.7{\%}-94.5{\%}) and 81.8{\%} (95{\%} CI: 48.3{\%}-97.7{\%}), respectively. Of the 79 patients with a medium-high pretest probability score, 67 were negative using HIT-IgG (PF4-H) test at our thresholds. HIMEA was performed on HIT-IgG positive patients. Using this combination, only one patient on 79 was incorrectly diagnosed. Conclusion Acustar HIT showed good performances to exclude the diagnosis of HIT. Combination with HIMEA improves PPV.",
keywords = "Heparin-induced thrombocytopenia, Immunoassay, Platelets",
author = "V. Minet and N. Bailly and J. Douxfils and Osselaer, {J. C.} and J. Laloy and C. Chatelain and I. Elalamy and B. Chatelain and Dogn{\'e}, {J. M.} and F. Mullier",
year = "2013",
month = "9",
day = "1",
doi = "10.1016/j.thromres.2013.06.004",
language = "English",
volume = "132",
pages = "352--359",
journal = "Thrombosis Research",
issn = "0049-3848",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Assessment of the performances of AcuStar HIT and the combination with heparin-induced multiple electrode aggregometry

T2 - A retrospective study

AU - Minet, V.

AU - Bailly, N.

AU - Douxfils, J.

AU - Osselaer, J. C.

AU - Laloy, J.

AU - Chatelain, C.

AU - Elalamy, I.

AU - Chatelain, B.

AU - Dogné, J. M.

AU - Mullier, F.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Background Early diagnosis of immune heparin-induced thrombocytopenia (HIT) is challenging. HemosIL® AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) were recently proposed as rapid diagnostic methods. Objectives We conducted a study to assess performances of AcuStar HIT-IgG (PF4-H) and AcuStar HIT-Ab (PF4-H). The secondary objective was to compare the performances of the combination of Acustar HIT and HIMEA with standardised clinical diagnosis. Methods Sera of 104 suspected HIT patients were retrospectively tested with AcuStar HIT. HIMEA was performed on available sera (n = 81). The clinical diagnosis was established by analysing in a standardized manner the patient's medical records. These tests were also compared with PF4-Enhanced®, LTA, and SRA in subsets of patients. Thresholds were determined using ROC curve analysis with clinical outcome as reference. Results Using the recommended thresholds (1.00 AU), the negative predictive value (NPV) of HIT-IgG and HIT-Ab were 100.0% (95% CI: 95.9%-100.0% and 95.7%-100.0%). The positive predictive value (PPV) were 64.3% (95% CI: 35.1%-87.2.2%) and 45.0% (95% CI: 23.2%-68.6%), respectively. Using our thresholds (HIT-IgG: 2.89 AU, HIT-Ab: 9.41 AU), NPV of HIT-IgG and HIT-Ab were 100.0% (95% CI: 96.0%-100.0% and 96.1%-100.0%). PPV were 75.0% (95% CI: 42.7%-94.5%) and 81.8% (95% CI: 48.3%-97.7%), respectively. Of the 79 patients with a medium-high pretest probability score, 67 were negative using HIT-IgG (PF4-H) test at our thresholds. HIMEA was performed on HIT-IgG positive patients. Using this combination, only one patient on 79 was incorrectly diagnosed. Conclusion Acustar HIT showed good performances to exclude the diagnosis of HIT. Combination with HIMEA improves PPV.

AB - Background Early diagnosis of immune heparin-induced thrombocytopenia (HIT) is challenging. HemosIL® AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) were recently proposed as rapid diagnostic methods. Objectives We conducted a study to assess performances of AcuStar HIT-IgG (PF4-H) and AcuStar HIT-Ab (PF4-H). The secondary objective was to compare the performances of the combination of Acustar HIT and HIMEA with standardised clinical diagnosis. Methods Sera of 104 suspected HIT patients were retrospectively tested with AcuStar HIT. HIMEA was performed on available sera (n = 81). The clinical diagnosis was established by analysing in a standardized manner the patient's medical records. These tests were also compared with PF4-Enhanced®, LTA, and SRA in subsets of patients. Thresholds were determined using ROC curve analysis with clinical outcome as reference. Results Using the recommended thresholds (1.00 AU), the negative predictive value (NPV) of HIT-IgG and HIT-Ab were 100.0% (95% CI: 95.9%-100.0% and 95.7%-100.0%). The positive predictive value (PPV) were 64.3% (95% CI: 35.1%-87.2.2%) and 45.0% (95% CI: 23.2%-68.6%), respectively. Using our thresholds (HIT-IgG: 2.89 AU, HIT-Ab: 9.41 AU), NPV of HIT-IgG and HIT-Ab were 100.0% (95% CI: 96.0%-100.0% and 96.1%-100.0%). PPV were 75.0% (95% CI: 42.7%-94.5%) and 81.8% (95% CI: 48.3%-97.7%), respectively. Of the 79 patients with a medium-high pretest probability score, 67 were negative using HIT-IgG (PF4-H) test at our thresholds. HIMEA was performed on HIT-IgG positive patients. Using this combination, only one patient on 79 was incorrectly diagnosed. Conclusion Acustar HIT showed good performances to exclude the diagnosis of HIT. Combination with HIMEA improves PPV.

KW - Heparin-induced thrombocytopenia

KW - Immunoassay

KW - Platelets

UR - http://www.scopus.com/inward/record.url?scp=84883816334&partnerID=8YFLogxK

U2 - 10.1016/j.thromres.2013.06.004

DO - 10.1016/j.thromres.2013.06.004

M3 - Article

AN - SCOPUS:84883816334

VL - 132

SP - 352

EP - 359

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

IS - 3

ER -