title: Heparin-induced multiple electrode aggregometry is a promising and useful functional tool for heparin-induced thrombocytopenia diagnosis: confirmation in a prospective study.
abstract: Heparin-induced thrombocytopenia (HIT) is a potentially lethal adverse effect of heparin therapy. Accurate and rapid HIT laboratory diagnosis when HIT is suspected is crucial. The combination of an immunological assay with a functional test improves the accuracy of HIT, but functional assays are currently limited to a few laboratories. Multiplate® analyzer (Dynabyte, Munich, Germany) is a practical, semi-automated and easy-to-perform platelet aggregation assay. The aim of this study is to explore whether heparin-induced platelet aggregation in whole blood assessed by Multiplate® (Heparin-induced multiple electrode aggregometry, HIMEA) can replace platelet aggregation test (PAT) in platelet-rich plasma. For this purpose, HIMEA performance in HIT diagnosis was prospectively evaluated. HIMEA and PAT were compared to serotonin-release assay (SRA) in 200 well-characterized consecutive patients suspected for HIT. HIMEA was found to be more sensitive (81% vs. 76%) and more specific (99% vs. 96%) than PAT compared to SRA. Both tests showed a high negative predictive value while HIMEA had a better positive predictive value. HIMEA has overall better performance characteristics than PAT for the detection of HIT platelet-activating antibodies. The combination of an immunological assay with HIMEA could be a feasible option in non-specialized laboratories for HIT diagnosis optimization.
authors.affiliation: Service d'Hématologie Biologique, Tenon University Hospital, Université Pierre et Marie Curie, 4 rue de la Chine, Paris 75020, France. vassiliki.galea@gmail.com
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Galea
authors.forename: Amir
authors.initials: A
authors.lastname: Khaterchi
authors.forename: Francoise
authors.initials: F
authors.lastname: Robert
authors.forename: Grigoris
authors.initials: G
authors.lastname: Gerotziafas
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hatmi
authors.forename: Ismail
authors.initials: I
authors.lastname: Elalamy
mesh_terms: D000906:Antibodies / Q000276:immunology; D000925:Anticoagulants / Q000009:adverse effects*; D004797:Enzyme-Linked Immunosorbent Assay; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D010974:Platelet Aggregation; D010978:Platelet Factor 4 / Q000276:immunology; D010979:Platelet Function Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis*
chemical_list: D000906:Antibodies; D000925:Anticoagulants; D010978:Platelet Factor 4; D006493:Heparin