Heparin-induced thrombocytopenia: construction of a pre-test diagnostic score derived from the analysis of a prospective multinational database, with internal validation.

Tardy-Poncet, Brigitte;de Maistre, Emmanuel;Pouplard, Claire;Presles, Emilie;GFHT-HIT study group;et.al.
(2021) Journal of thrombosis and haemostasis — Vol. 19, n° 8, p. 1959-1972 (2021)

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Authors
  • Tardy-Poncet, Brigitteorcid-logo
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  • de Maistre, Emmanuel
    Author
  • Pouplard, Claire
    Author
  • Presles, Emilie
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  • Mullier, FrançoisUCLouvain
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  • GFHT-HIT study group
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Abstract
(en) BACKGROUND: Diagnosis of heparin-induced thrombocytopenia (HIT) requires pretest probability assessment and dedicated laboratory assays. OBJECTIVE: To develop a pretest score for HIT. DESIGN: Observational; analysis of prospectively collected data of hospitalized patients suspected with HIT (ClinicalTrials.gov NCT00748839). SETTING: Thirty-one tertiary hospitals in France, Switzerland, and Belgium. PATIENTS: Patients tested for HIT antibodies (2280 evaluable), randomly allocated to derivation and validation cohorts. MEASUREMENTS: Independent adjudicators diagnosed HIT based on the prospectively collected data and serotonin release assay results. RESULTS: Heparin-induced thrombocytopenia was diagnosed in 234 (14.7%) and 99 (14.5%) patients in the two cohorts. Eight features were associated with HIT (in brackets, points assigned for score calculation of the score): unfractionated heparin (1); therapeutic-dose heparin (1); cardiopulmonary bypass (cardiac surgery) (2); major trauma (3); 5- to 21-day interval from anticoagulation initiation to suspicion of HIT (4); ≥40% decrease in platelet count over ≤6 days (3); thrombotic event, arterial (3) or venous (3). The C-statistic was 0.79 (95% CI, 0.76-0.82). In the validation cohort, the area under the receiver operating characteristic curve was 0.77 (95% CI, 0.74-0.80). Three groups of scores were defined; HIT prevalence reached almost 30% in the high-probability group. LIMITATION: The performance of the score may depend on settings and practices. CONCLUSION: The objective, easy-to-collect, clinical features of HIT we evidenced were incorporated into a pretest score, which may guide clinical decisions regarding diagnostic testing and anticoagulation.
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Tardy-Poncet, B., de Maistre, E., Pouplard, C., Presles, E., Alhenc-Gelas, M., Lasne, D., Horellou, M.-H., Mouton, C., Serre-Sapin, A., Bauters, A., Nguyen, P., Mullier, F., Perrin, J., Le Gal, G., Morange, P.-E., Grunebaum, L., Lillo-Le Louet, A., Elalamy, I., Gruel, Y., et al. (2021). Heparin-induced thrombocytopenia: construction of a pre-test diagnostic score derived from the analysis of a prospective multinational database, with internal validation. Journal of thrombosis and haemostasis, 19(8), 1959-1972. https://doi.org/10.1111/jth.15344 (Original work published 2021)