title: Prospective multicentre cohort study of heparin-induced thrombocytopenia in acute ischaemic stroke patients.
abstract: Acute ischaemic stroke patients sometimes receive heparin for treatment and/or prophylaxis of thromboembolic complications. This study was designed to elucidate the incidence and clinical features of heparin-induced thrombocytopenia (HIT) in acute stroke patients treated with heparin. We conducted a prospective multicentre cohort study of 267 patients who were admitted to three stroke centres within 7 d after stroke onset. We examined clinical data until discharge and collected blood samples on days 1 and 14 of hospitalization to test anti-platelet factor 4/heparin antibodies (anti-PF4/H Abs) using an enzyme-linked immunosorbent assay (ELISA); platelet-activating antibodies were identified by serotonin-release assay (SRA). Patients with a 4Ts score ≥4 points, positive-ELISA, and positive-SRA were diagnosed as definite HIT. Heparin was administered to 172 patients (64·4%: heparin group). Anti-PF4/H Abs were detected by ELISA in 22 cases (12·8%) in the heparin group. Seven patients had 4Ts ≥ 4 points. Among them, three patients (1·7% overall) were also positive by both ELISA and SRA. National Institutes of Health Stroke Scale score on admission was high (range, 16-23) and in-hospital mortality was very high (66·7%) in definite HIT patients. In this study, the incidence of definite HIT in acute ischaemic stroke patients treated with heparin was 1·7% (95% confidence interval: 0·4-5·0). The clinical severity and outcome of definite HIT were unfavourable.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawano
authors.forename: Haruko
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Shigeki
authors.initials: S
authors.lastname: Miyata
authors.forename: Manabu
authors.initials: M
authors.lastname: Izumi
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hirano
authors.forename: Naomi
authors.initials: N
authors.lastname: Toratani
authors.forename: Isami
authors.initials: I
authors.lastname: Kakutani
authors.forename: Jo-Ann I
authors.initials: JA
authors.lastname: Sheppard
authors.forename: Theodore E
authors.initials: TE
authors.lastname: Warkentin
authors.forename: Akiko
authors.initials: A
authors.lastname: Kada
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Okamoto
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Naritomi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.forename: Makoto
authors.initials: M
authors.lastname: Uchino
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000276:immunology; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D001323:Autoantibodies; D010978:Platelet Factor 4; D006493:Heparin