Heparin-induced thrombocytopenia in multidisciplinary hospital: the original diagnostic “Rule” and new treatment algorithm is able to reduce mortality rate: a 3-year observation study

Research output

Abstract

Introduction. Heparins are one of the most frequently prescribed drugs in the world due to PE prophylaxis and treatment, just as heparin prevention “bridge” often used perioperatively in those constantly receiving oral anticoagulants. Heparin-induced thrombocytopenia (HIT) is an immune-mediated life-threatening complication, accompanied by paradoxical thrombosis and high mortality rate (up to 30%). Immunodiagnostics of HIT is rather expensive. Existing scales of probability of HIT (for coronary shunting; expert Scale HEP and Scale "4-x T") are too difficult, have low specificity and lead to overdiagnosis. Our aim was to determine the incidence of HIT in multidisciplinary hospital before and after implementation of the original diagnostic "Rule" - “100-5-100” (that means “decrease in platelet counts less than 100×109/L on the 5-th day of Heparins use or within 100 days of their previous use”) and new Algorithm of HIT treatment (including Fondaparinux sodium as alternative anticoagulant). Patients, materials and methods. At the beginning of 2014 the stuff have been informed in original "Rule" (see above) and Algorithm. Patiens were studied by electronic medical Records before the implementation of the "Rule" and Algorithm ("control group" hospitalized from 01.01.2013 to 31.01.2013) and after its implementation ("comparison group" - those hospitalized from 01.01.2014 to 31.12.2015). In some cases HIT diagnosis was confirmed by a method of immunoturbidimetry (ACL TOP 700). Results. We identified severe thrombocytopenia in 5018 blood samples obtained in 950 patients (1.3% of admissions). 382 of them received Heparins (40.2%). The implementation of "Rule" and Algorithm was accompanied by a decrease in the HIT incidence in 2014-2015 about 2 times compared to 2013. That was particularly noticeable in the departments of cardiac surgery, traumatology, urology and vascular surgery, as well as in intensive care units (ICU). There was a significant decrease in mortality rates in ICU patients from 26.1% in 2013 to 9.8% in 2014 (p<0.05) and 7.5% in 2015 (p<0.05). No noticeable dynamics in patients with "non-heparin" thrombocytopenia was observed. Conclusion. The use of the original "Rule" of HIT diagnostics and treatment Algorithm contributed to a decrease in the HIT incidence and the frequency of complicated HIT, which was manifested by a significant decrease in the number of such cases in the ICU with a statistically meaningful reduction in mortality rates. Sodium fondaparinux is an affordable, effective and safe drug of choice in the treatment of HIT.
Original languageEnglish
Title of host publicationHEPARIN-INDUCED THROMBOCYTOPENIA IN MULTIDISCIPLINARY HOSPITAL: THE ORIGINAL DIAGNOSTIC "RULE" AND NEW TREATMENT ALGORITHM ARE ABLE TO REDUCE HARD COMLICATIONS
Subtitle of host publicationA 3-YEAR STUDY
EditorsMasatoshi Makuuchi, Tokyo, Japan, Nuh N. Rahbari, Mannheim, Germany
Place of PublicationMoscow
PublisherCelsius Publishing House
Pages239-240
Number of pages2
Volume23, supplement 1
ISBN (Electronic)e-ISSN 2601 -1700
ISBN (Print)2559 - 723X
Publication statusPublished - Oct 2018

Publication series

Nameofficial journal of the International Association of Surgeons and Gastroenterologists and Oncologists
Number1
Volume23
ISSN (Print)2559-723X
ISSN (Electronic)2601-1700

Scopus subject areas

  • Medicine(all)

Cite this

Семиголовский, Н. Ю., & Semigolovski, S. (2018). Heparin-induced thrombocytopenia in multidisciplinary hospital: the original diagnostic “Rule” and new treatment algorithm is able to reduce mortality rate: a 3-year observation study . In M. Makuuchi, Tokyo, Japan, & N. N. Rahbari, Mannheim, Germany (Eds.), HEPARIN-INDUCED THROMBOCYTOPENIA IN MULTIDISCIPLINARY HOSPITAL: THE ORIGINAL DIAGNOSTIC "RULE" AND NEW TREATMENT ALGORITHM ARE ABLE TO REDUCE HARD COMLICATIONS : A 3-YEAR STUDY (Vol. 23, supplement 1, pp. 239-240). [362] (official journal of the International Association of Surgeons and Gastroenterologists and Oncologists; Vol. 23, No. 1). Moscow: Celsius Publishing House.
Семиголовский, Никита Юрьевич ; Semigolovski, Savva. / Heparin-induced thrombocytopenia in multidisciplinary hospital: the original diagnostic “Rule” and new treatment algorithm is able to reduce mortality rate : a 3-year observation study . HEPARIN-INDUCED THROMBOCYTOPENIA IN MULTIDISCIPLINARY HOSPITAL: THE ORIGINAL DIAGNOSTIC "RULE" AND NEW TREATMENT ALGORITHM ARE ABLE TO REDUCE HARD COMLICATIONS : A 3-YEAR STUDY. editor / Masatoshi Makuuchi, Tokyo, Japan ; Nuh N. Rahbari, Mannheim, Germany. Vol. 23, supplement 1 Moscow : Celsius Publishing House, 2018. pp. 239-240 (official journal of the International Association of Surgeons and Gastroenterologists and Oncologists; 1).
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abstract = "Introduction. Heparins are one of the most frequently prescribed drugs in the world due to PE prophylaxis and treatment, just as heparin prevention “bridge” often used perioperatively in those constantly receiving oral anticoagulants. Heparin-induced thrombocytopenia (HIT) is an immune-mediated life-threatening complication, accompanied by paradoxical thrombosis and high mortality rate (up to 30{\%}). Immunodiagnostics of HIT is rather expensive. Existing scales of probability of HIT (for coronary shunting; expert Scale HEP and Scale {"}4-x T{"}) are too difficult, have low specificity and lead to overdiagnosis. Our aim was to determine the incidence of HIT in multidisciplinary hospital before and after implementation of the original diagnostic {"}Rule{"} - “100-5-100” (that means “decrease in platelet counts less than 100×109/L on the 5-th day of Heparins use or within 100 days of their previous use”) and new Algorithm of HIT treatment (including Fondaparinux sodium as alternative anticoagulant). Patients, materials and methods. At the beginning of 2014 the stuff have been informed in original {"}Rule{"} (see above) and Algorithm. Patiens were studied by electronic medical Records before the implementation of the {"}Rule{"} and Algorithm ({"}control group{"} hospitalized from 01.01.2013 to 31.01.2013) and after its implementation ({"}comparison group{"} - those hospitalized from 01.01.2014 to 31.12.2015). In some cases HIT diagnosis was confirmed by a method of immunoturbidimetry (ACL TOP 700). Results. We identified severe thrombocytopenia in 5018 blood samples obtained in 950 patients (1.3{\%} of admissions). 382 of them received Heparins (40.2{\%}). The implementation of {"}Rule{"} and Algorithm was accompanied by a decrease in the HIT incidence in 2014-2015 about 2 times compared to 2013. That was particularly noticeable in the departments of cardiac surgery, traumatology, urology and vascular surgery, as well as in intensive care units (ICU). There was a significant decrease in mortality rates in ICU patients from 26.1{\%} in 2013 to 9.8{\%} in 2014 (p<0.05) and 7.5{\%} in 2015 (p<0.05). No noticeable dynamics in patients with {"}non-heparin{"} thrombocytopenia was observed. Conclusion. The use of the original {"}Rule{"} of HIT diagnostics and treatment Algorithm contributed to a decrease in the HIT incidence and the frequency of complicated HIT, which was manifested by a significant decrease in the number of such cases in the ICU with a statistically meaningful reduction in mortality rates. Sodium fondaparinux is an affordable, effective and safe drug of choice in the treatment of HIT.",
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Семиголовский, НЮ & Semigolovski, S 2018, Heparin-induced thrombocytopenia in multidisciplinary hospital: the original diagnostic “Rule” and new treatment algorithm is able to reduce mortality rate: a 3-year observation study . in M Makuuchi, Tokyo, Japan & NN Rahbari, Mannheim, Germany (eds), HEPARIN-INDUCED THROMBOCYTOPENIA IN MULTIDISCIPLINARY HOSPITAL: THE ORIGINAL DIAGNOSTIC "RULE" AND NEW TREATMENT ALGORITHM ARE ABLE TO REDUCE HARD COMLICATIONS : A 3-YEAR STUDY. vol. 23, supplement 1, 362, official journal of the International Association of Surgeons and Gastroenterologists and Oncologists, no. 1, vol. 23, Celsius Publishing House, Moscow, pp. 239-240.

Heparin-induced thrombocytopenia in multidisciplinary hospital: the original diagnostic “Rule” and new treatment algorithm is able to reduce mortality rate : a 3-year observation study . / Семиголовский, Никита Юрьевич; Semigolovski, Savva.

HEPARIN-INDUCED THROMBOCYTOPENIA IN MULTIDISCIPLINARY HOSPITAL: THE ORIGINAL DIAGNOSTIC "RULE" AND NEW TREATMENT ALGORITHM ARE ABLE TO REDUCE HARD COMLICATIONS : A 3-YEAR STUDY. ed. / Masatoshi Makuuchi, Tokyo, Japan; Nuh N. Rahbari, Mannheim, Germany. Vol. 23, supplement 1 Moscow : Celsius Publishing House, 2018. p. 239-240 362 (official journal of the International Association of Surgeons and Gastroenterologists and Oncologists; Vol. 23, No. 1).

Research output

TY - GEN

T1 - Heparin-induced thrombocytopenia in multidisciplinary hospital: the original diagnostic “Rule” and new treatment algorithm is able to reduce mortality rate

T2 - a 3-year observation study

AU - Семиголовский, Никита Юрьевич

AU - Semigolovski, Savva

PY - 2018/10

Y1 - 2018/10

N2 - Introduction. Heparins are one of the most frequently prescribed drugs in the world due to PE prophylaxis and treatment, just as heparin prevention “bridge” often used perioperatively in those constantly receiving oral anticoagulants. Heparin-induced thrombocytopenia (HIT) is an immune-mediated life-threatening complication, accompanied by paradoxical thrombosis and high mortality rate (up to 30%). Immunodiagnostics of HIT is rather expensive. Existing scales of probability of HIT (for coronary shunting; expert Scale HEP and Scale "4-x T") are too difficult, have low specificity and lead to overdiagnosis. Our aim was to determine the incidence of HIT in multidisciplinary hospital before and after implementation of the original diagnostic "Rule" - “100-5-100” (that means “decrease in platelet counts less than 100×109/L on the 5-th day of Heparins use or within 100 days of their previous use”) and new Algorithm of HIT treatment (including Fondaparinux sodium as alternative anticoagulant). Patients, materials and methods. At the beginning of 2014 the stuff have been informed in original "Rule" (see above) and Algorithm. Patiens were studied by electronic medical Records before the implementation of the "Rule" and Algorithm ("control group" hospitalized from 01.01.2013 to 31.01.2013) and after its implementation ("comparison group" - those hospitalized from 01.01.2014 to 31.12.2015). In some cases HIT diagnosis was confirmed by a method of immunoturbidimetry (ACL TOP 700). Results. We identified severe thrombocytopenia in 5018 blood samples obtained in 950 patients (1.3% of admissions). 382 of them received Heparins (40.2%). The implementation of "Rule" and Algorithm was accompanied by a decrease in the HIT incidence in 2014-2015 about 2 times compared to 2013. That was particularly noticeable in the departments of cardiac surgery, traumatology, urology and vascular surgery, as well as in intensive care units (ICU). There was a significant decrease in mortality rates in ICU patients from 26.1% in 2013 to 9.8% in 2014 (p<0.05) and 7.5% in 2015 (p<0.05). No noticeable dynamics in patients with "non-heparin" thrombocytopenia was observed. Conclusion. The use of the original "Rule" of HIT diagnostics and treatment Algorithm contributed to a decrease in the HIT incidence and the frequency of complicated HIT, which was manifested by a significant decrease in the number of such cases in the ICU with a statistically meaningful reduction in mortality rates. Sodium fondaparinux is an affordable, effective and safe drug of choice in the treatment of HIT.

AB - Introduction. Heparins are one of the most frequently prescribed drugs in the world due to PE prophylaxis and treatment, just as heparin prevention “bridge” often used perioperatively in those constantly receiving oral anticoagulants. Heparin-induced thrombocytopenia (HIT) is an immune-mediated life-threatening complication, accompanied by paradoxical thrombosis and high mortality rate (up to 30%). Immunodiagnostics of HIT is rather expensive. Existing scales of probability of HIT (for coronary shunting; expert Scale HEP and Scale "4-x T") are too difficult, have low specificity and lead to overdiagnosis. Our aim was to determine the incidence of HIT in multidisciplinary hospital before and after implementation of the original diagnostic "Rule" - “100-5-100” (that means “decrease in platelet counts less than 100×109/L on the 5-th day of Heparins use or within 100 days of their previous use”) and new Algorithm of HIT treatment (including Fondaparinux sodium as alternative anticoagulant). Patients, materials and methods. At the beginning of 2014 the stuff have been informed in original "Rule" (see above) and Algorithm. Patiens were studied by electronic medical Records before the implementation of the "Rule" and Algorithm ("control group" hospitalized from 01.01.2013 to 31.01.2013) and after its implementation ("comparison group" - those hospitalized from 01.01.2014 to 31.12.2015). In some cases HIT diagnosis was confirmed by a method of immunoturbidimetry (ACL TOP 700). Results. We identified severe thrombocytopenia in 5018 blood samples obtained in 950 patients (1.3% of admissions). 382 of them received Heparins (40.2%). The implementation of "Rule" and Algorithm was accompanied by a decrease in the HIT incidence in 2014-2015 about 2 times compared to 2013. That was particularly noticeable in the departments of cardiac surgery, traumatology, urology and vascular surgery, as well as in intensive care units (ICU). There was a significant decrease in mortality rates in ICU patients from 26.1% in 2013 to 9.8% in 2014 (p<0.05) and 7.5% in 2015 (p<0.05). No noticeable dynamics in patients with "non-heparin" thrombocytopenia was observed. Conclusion. The use of the original "Rule" of HIT diagnostics and treatment Algorithm contributed to a decrease in the HIT incidence and the frequency of complicated HIT, which was manifested by a significant decrease in the number of such cases in the ICU with a statistically meaningful reduction in mortality rates. Sodium fondaparinux is an affordable, effective and safe drug of choice in the treatment of HIT.

KW - тромбоцитопения, гепарины, гепарин-индуцированная тромбоцитопения (ГИТ), иммунодиагностика, тромбоз

M3 - Conference contribution

SN - 2559 - 723X

VL - 23, supplement 1

T3 - official journal of the International Association of Surgeons and Gastroenterologists and Oncologists

SP - 239

EP - 240

BT - HEPARIN-INDUCED THROMBOCYTOPENIA IN MULTIDISCIPLINARY HOSPITAL: THE ORIGINAL DIAGNOSTIC "RULE" AND NEW TREATMENT ALGORITHM ARE ABLE TO REDUCE HARD COMLICATIONS

A2 - Makuuchi, Tokyo, Japan, Masatoshi

A2 - Rahbari, Mannheim, Germany, Nuh N.

PB - Celsius Publishing House

CY - Moscow

ER -

Семиголовский НЮ, Semigolovski S. Heparin-induced thrombocytopenia in multidisciplinary hospital: the original diagnostic “Rule” and new treatment algorithm is able to reduce mortality rate: a 3-year observation study . In Makuuchi, Tokyo, Japan M, Rahbari, Mannheim, Germany NN, editors, HEPARIN-INDUCED THROMBOCYTOPENIA IN MULTIDISCIPLINARY HOSPITAL: THE ORIGINAL DIAGNOSTIC "RULE" AND NEW TREATMENT ALGORITHM ARE ABLE TO REDUCE HARD COMLICATIONS : A 3-YEAR STUDY. Vol. 23, supplement 1. Moscow: Celsius Publishing House. 2018. p. 239-240. 362. (official journal of the International Association of Surgeons and Gastroenterologists and Oncologists; 1).