Evaluation and management of thrombocytopenia and suspected heparin-induced thrombocytopenia in hospitalized patients: The Complications After Thrombocytopenia Caused by Heparin (CATCH) registry

被引：37

作者：

Crespo, Eric M. ^{[1
]}

Oliveira, Gustavo B. F. ^{[2
,3
]}

Honeycutt, Emily F. ^{[2
,3
]}

Becker, Richard C. ^{[2
,3
]}

Berger, Peter B. ^{[4
]}

Moliterno, David J. ^{[5
]}

Anstrom, Kevin J. ^{[2
,3
]}

Abrams, Charles S. ^{[6
]}

Kleiman, Neal S. ^{[7
]}

Moll, Stephan ^{[8
]}

Rice, Lawrence ^{[9
]}

Rodgers, Jo E. ^{[8
]}

Steinhubl, Steven R. ^{[10
]}

Tapson, Victor F. ^{[2
,3
]}

Granger, Christopher B. ^{[2
,3
]}

Ohman, E. Magnus ^{[2
,3
]}

机构：

[1] Univ Vermont, Burlington, VT USA

[2] Duke Univ, Med Ctr, Duke Translat Med Inst, Durham, NC USA

[3] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA

[4] Weis Ctr Res, Geisinger Clin, Danville, PA 17822 USA

[5] Univ Kentucky, Lexington, KY USA

[6] Univ Penn, Sch Med, Philadelphia, PA 19104 USA

[7] Methodist DeBakey Heart Ctr, Houston, TX USA

[8] Univ N Carolina, Chapel Hill, NC 27515 USA

[9] Baylor Coll Med, Houston, TX 77030 USA

[10] Medicines Co, Zurich, Switzerland

来源：

AMERICAN HEART JOURNAL | 2009年 / 157卷 / 04期

关键词：

DIAGNOSIS;

D O I：

10.1016/j.ahj.2009.01.005

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Thrombocytopenia and heparin-induced thrombocytopenia (HIT) are potentially devastating paradoxical side effects of heparin therapy. We explored the evaluation, management, and clinical consequences of thrombocytopenia occurring during heparin therapy in diverse clinical settings. Methods CATCH was a prospective observational study that enrolled 3,536 patients in 48 US hospitals. Data were collected on 3 strata: patients receiving any form of heparin for :96 hours (n = 2,420); cardiac care unit (CCU) patients treated with heparin who developed thrombocytopenia (n = 1,090); patients who had an HIT assay performed (n = 449). Results Thrombocytopenia occurred in 36.4% of patients in the prolonged heparin stratum and was associated with an increased risk of death or thromboembolic complication (OR 1.5, 95% Cl 1.2-1.9). Among a subset of patients whose clinical presentation suggested they were at high risk for HIT, suspicion for HIT was uncommon (prolonged heparin stratum 19.8%, CCU stratum 37.6%) and often did not arise until >= 1 day after patients developed thrombocytopenia. Often patients were not evaluated for HIT until after they had had a thromboembolic complication (prolonged heparin stratum 43.8%, CCU stratum 61%). Even after HIT was suspected, patients often continued to receive heparin. Direct thrombin inhibitor use was infrequent (prolonged heparin stratum 29.4%, CCU stratum 35.6%). Among the few patients who underwent evaluation, HIT was confirmed in 46.7% of the prolonged heparin stratum and 31.4% of the CCU stratum. Conclusions Thrombocytopenia is common among patients receiving heparin, and it is associated with substantial risk for catastrophic complications. Despite the high risk for HIT in this population, recognition, evaluation, and appropriate treatment are infrequent and delayed. (Am Heart J 2009; 157:651-7.)

引用

页码：651 / 657

页数：7

共 12 条

[1] Heparin-induced thrombocytopenia [J].