Rapid exclusion of the diagnosis of immune HIT by AcuStar HIT and heparin-induced multiple electrode aggregometry

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Abstract

Background Accurate diagnosis of heparin-induced thrombocytopenia (HIT) is essential but remains challenging. We have previously demonstrated, in a retrospective study, the usefulness of the combination of the 4Ts score, AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) with optimized thresholds. Objectives We aimed at exploring prospectively the performances of our optimized diagnostic algorithm on suspected HIT patients. The secondary objective is to evaluate performances of AcuStar HIT-Ab (PF4-H) in comparison with the clinical outcome. Methods 116 inpatients with clinically suspected immune HIT were included. Our optimized diagnostic algorithm was applied to each patient. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) of the overall diagnostic strategy as well as AcuStar HIT-Ab (at manufacturer's thresholds and at our thresholds) were calculated using clinical diagnosis as the reference. Results Among 116 patients, 2 patients had clinically-diagnosed HIT. These 2 patients were positive on AcuStar HIT-Ab, AcuStar HIT-IgG and HIMEA. Using our optimized algorithm, all patients were correctly diagnosed. AcuStar HIT-Ab at our cut-off (> 9.41 U/mL) and at manufacturer's cut-off (> 1.00 U/mL) showed both a sensitivity of 100.0% and a specificity of 99.1% and 90.4%, respectively. Conclusion The combination of the 4Ts score, the HemosIL® AcuStar HIT and HIMEA with optimized thresholds may be useful for the rapid and accurate exclusion of the diagnosis of immune HIT. © 2014 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)1074-1078
Number of pages5
JournalThrombosis Research
Volume133
Issue number6
DOIs
Publication statusPublished - 30 Jun 2014

Fingerprint

Thrombocytopenia
Heparin
Electrodes
Inpatients
Retrospective Studies
Immunoglobulin G

Keywords

  • HemosIL AcuStar HIT
  • heparin-induced multiple electrode aggregometry
  • immune heparin-induced thrombocytopenia

Cite this

@article{08ec2eeb788941fd84c538ac6fdab971,
title = "Rapid exclusion of the diagnosis of immune HIT by AcuStar HIT and heparin-induced multiple electrode aggregometry",
abstract = "Background Accurate diagnosis of heparin-induced thrombocytopenia (HIT) is essential but remains challenging. We have previously demonstrated, in a retrospective study, the usefulness of the combination of the 4Ts score, AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) with optimized thresholds. Objectives We aimed at exploring prospectively the performances of our optimized diagnostic algorithm on suspected HIT patients. The secondary objective is to evaluate performances of AcuStar HIT-Ab (PF4-H) in comparison with the clinical outcome. Methods 116 inpatients with clinically suspected immune HIT were included. Our optimized diagnostic algorithm was applied to each patient. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) of the overall diagnostic strategy as well as AcuStar HIT-Ab (at manufacturer's thresholds and at our thresholds) were calculated using clinical diagnosis as the reference. Results Among 116 patients, 2 patients had clinically-diagnosed HIT. These 2 patients were positive on AcuStar HIT-Ab, AcuStar HIT-IgG and HIMEA. Using our optimized algorithm, all patients were correctly diagnosed. AcuStar HIT-Ab at our cut-off (> 9.41 U/mL) and at manufacturer's cut-off (> 1.00 U/mL) showed both a sensitivity of 100.0{\%} and a specificity of 99.1{\%} and 90.4{\%}, respectively. Conclusion The combination of the 4Ts score, the HemosIL{\circledR} AcuStar HIT and HIMEA with optimized thresholds may be useful for the rapid and accurate exclusion of the diagnosis of immune HIT. {\circledC} 2014 Elsevier Ltd. All rights reserved.",
keywords = "HemosIL AcuStar HIT, heparin-induced multiple electrode aggregometry, immune heparin-induced thrombocytopenia",
author = "V Minet and J Baudar and N Bailly and J Douxfils and J Laloy and S Lessire and M Gourdin and B Devalet and B Chatelain and Dogn{\'e}, {J M} and F Mullier",
note = "Copyright {\circledC} 2014 Elsevier Ltd. All rights reserved.",
year = "2014",
month = "6",
day = "30",
doi = "10.1016/j.thromres.2014.01.014",
language = "English",
volume = "133",
pages = "1074--1078",
journal = "Thrombosis Research",
issn = "0049-3848",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Rapid exclusion of the diagnosis of immune HIT by AcuStar HIT and heparin-induced multiple electrode aggregometry

AU - Minet, V

AU - Baudar, J

AU - Bailly, N

AU - Douxfils, J

AU - Laloy, J

AU - Lessire, S

AU - Gourdin, M

AU - Devalet, B

AU - Chatelain, B

AU - Dogné, J M

AU - Mullier, F

N1 - Copyright © 2014 Elsevier Ltd. All rights reserved.

PY - 2014/6/30

Y1 - 2014/6/30

N2 - Background Accurate diagnosis of heparin-induced thrombocytopenia (HIT) is essential but remains challenging. We have previously demonstrated, in a retrospective study, the usefulness of the combination of the 4Ts score, AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) with optimized thresholds. Objectives We aimed at exploring prospectively the performances of our optimized diagnostic algorithm on suspected HIT patients. The secondary objective is to evaluate performances of AcuStar HIT-Ab (PF4-H) in comparison with the clinical outcome. Methods 116 inpatients with clinically suspected immune HIT were included. Our optimized diagnostic algorithm was applied to each patient. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) of the overall diagnostic strategy as well as AcuStar HIT-Ab (at manufacturer's thresholds and at our thresholds) were calculated using clinical diagnosis as the reference. Results Among 116 patients, 2 patients had clinically-diagnosed HIT. These 2 patients were positive on AcuStar HIT-Ab, AcuStar HIT-IgG and HIMEA. Using our optimized algorithm, all patients were correctly diagnosed. AcuStar HIT-Ab at our cut-off (> 9.41 U/mL) and at manufacturer's cut-off (> 1.00 U/mL) showed both a sensitivity of 100.0% and a specificity of 99.1% and 90.4%, respectively. Conclusion The combination of the 4Ts score, the HemosIL® AcuStar HIT and HIMEA with optimized thresholds may be useful for the rapid and accurate exclusion of the diagnosis of immune HIT. © 2014 Elsevier Ltd. All rights reserved.

AB - Background Accurate diagnosis of heparin-induced thrombocytopenia (HIT) is essential but remains challenging. We have previously demonstrated, in a retrospective study, the usefulness of the combination of the 4Ts score, AcuStar HIT and heparin-induced multiple electrode aggregometry (HIMEA) with optimized thresholds. Objectives We aimed at exploring prospectively the performances of our optimized diagnostic algorithm on suspected HIT patients. The secondary objective is to evaluate performances of AcuStar HIT-Ab (PF4-H) in comparison with the clinical outcome. Methods 116 inpatients with clinically suspected immune HIT were included. Our optimized diagnostic algorithm was applied to each patient. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) of the overall diagnostic strategy as well as AcuStar HIT-Ab (at manufacturer's thresholds and at our thresholds) were calculated using clinical diagnosis as the reference. Results Among 116 patients, 2 patients had clinically-diagnosed HIT. These 2 patients were positive on AcuStar HIT-Ab, AcuStar HIT-IgG and HIMEA. Using our optimized algorithm, all patients were correctly diagnosed. AcuStar HIT-Ab at our cut-off (> 9.41 U/mL) and at manufacturer's cut-off (> 1.00 U/mL) showed both a sensitivity of 100.0% and a specificity of 99.1% and 90.4%, respectively. Conclusion The combination of the 4Ts score, the HemosIL® AcuStar HIT and HIMEA with optimized thresholds may be useful for the rapid and accurate exclusion of the diagnosis of immune HIT. © 2014 Elsevier Ltd. All rights reserved.

KW - HemosIL AcuStar HIT

KW - heparin-induced multiple electrode aggregometry

KW - immune heparin-induced thrombocytopenia

UR - http://www.scopus.com/inward/record.url?scp=84900499280&partnerID=8YFLogxK

U2 - 10.1016/j.thromres.2014.01.014

DO - 10.1016/j.thromres.2014.01.014

M3 - Article

C2 - 24485951

VL - 133

SP - 1074

EP - 1078

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

IS - 6

ER -