Prognostic factors for patients with heparin-induced thrombocytopenia: a systematic review
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REVIEW ARTICLE
Prognostic factors for patients with heparin-induced thrombocytopenia: a systematic review Giorgia Colarossi1 · Heike Schnöring1 · Andromahi Trivellas2 · Marcel Betsch3 · Nima Hatam1 · Jörg Eschweiler4 · Markus Tingart4 · Filippo Migliorini4 Received: 13 May 2020 / Accepted: 23 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background Little is known with regards to the prognostic factors for patients with suspected or diagnosed Heparin-Induced Thromobocytopenia (HIT). The role of patient and therapy characteristics may play a role in predicting the outcome. Aim of the review To investigate the role of patient and therapy characteristics as potential prognostic factors for HIT-related complications (haemorrhagic and thromboembolic events), and mortality. Method The present systematic review was conducted according to the PRISMA statement. In September 2020, the main online databases were accessed: Pubmed, EMBASE, Scopus, Google Scholar. All the clinical trials concerning the management of patients with suspected or confirmed HIT were eligible. Studies evaluating the use of oral anticoagulants (e.g. vitamin K antagonists, Apixaban) were not considered, along with those comparing the use of heparin. For pairwise correlation, the Pearson Product-Moment Correlation Coefficient (r) was used. The final effect was evaluated according to the Cauchy–Schwarz inequality.Results Data from 33 clinical studies (4338 patients) were retrieved. The overall mean age was 62.3 ± 6.6 years old. Patients with HIT-related thromboembolism at the moment of diagnosis were associated with greater rate of haemorrhages (P > 0.0001), thromboembolism (P > 0.0001) and mortality (P = 0.001). Patients with more comorbidities at diagnosis were associated with a greater risk of haemorrhages (P = 0.07), thromboembolism (P = 0.002) and mortality (P = 0.002). Patients with longer duration of the therapy were associated with lower rate of mortality (P = 0.04). ConclusionsPatient comorbidities, presence of HIT-related thromboembolism on admission and shorter anticoagulant therapy were found to be negative prognostic factors. Thrombocythemia on admission, patients age and gender did not influence the overall outcome. Keywords Heparin-induced thrombocytopenia · HIT · Prognostic factors · Systematic review
Impacts on practice • The optimal management of heparin-induced thrombo* Filippo Migliorini [email protected] 1
Department of Cardiac and Thoracic Surgery, RWTH Aachen University Clinic, Pauwelstr. 31, Aachen, 52074, Germany
2
Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
3
Women´s College Hospital, University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Toronto, ON, Canada
4
Department of Orthopaedics Surgery, RWTH Aachen University Clinic, Pauwelstr. 31, Aachen 52074, Germany
cytopenia is still controversial and further high-quality studies are required. • Patient comorbidities, presence of heparin-induced thrombocytopenia related thromboe
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