CC-BY 4.0 · TH Open 2018; 02(01): e49-e53
DOI: 10.1055/s-0038-1624565
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Heparin-Induced Thrombocytopenia in Healthy Individuals with Continuous Heparin Infusion

Jonathan S. Williams
Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Paula J. Autori
Center for Clinical Investigations, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Stephen K. Kidd
Department of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois, United States
,
Gregory Piazza
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Molly C. Connors
Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Charles A. Czeisler
Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Karine D. Scheuermaier
Wits Sleep Laboratory, University of the Witwatersrand, Johannesburg, Braamfontein, South Africa
,
Jeanne Duffy
Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Elizabeth B. Klerman
Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Frank A. Scheer
Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Marjorie Kozak
Center for Clinical Investigations, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Sheila M. Driscoll
Center for Clinical Investigations, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Samuel Z. Goldhaber
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

21 September 2017

05 December 2017

Publication Date:
30 January 2018 (online)

Abstract

The risk for developing heparin-induced thrombocytopenia in healthy individuals is thought to be low, but monitoring recommendations remain controversial. Therefore, a retrospective cohort study was conducted to identify the incidence of thrombocytopenic events in a healthy research population exposed and re-exposed to continuous intravenous (IV) unfractionated heparin. The Division of Sleep Medicine and the Centre for Clinical Investigations at Brigham and Women's Hospital, Boston, Massachusetts, United States, instituted a standardized platelet monitoring procedure for all research protocols that involved heparin to detect platelet count decreases. Protocol-related frequent blood sampling required use of continuous IV unfractionated heparin infusion (5,000 unit/L in 0.45% saline at 40 mL/h) to maintain line patency over extended periods of IV access. From the years 2009 to 2012, a total of 273 healthy volunteers enrolled in Sleep Medicine research protocols met study criteria as having been exposed and/or re-exposed to continuously infused intravenous heparin for at least 4 hours. The mean continuous heparin exposure time was 88 ± 82 SD hours with a total of 397 heparin exposure and re-exposure events. Platelet count measurements were obtained on 629 occasions, representing a range from 2 to 9 draws per participant. No platelet count decrease of more than 50% was detected. There were no detected adverse bleeding or thrombotic events. In this retrospective study of healthy volunteers involved in a rigorously applied inpatient platelet monitoring protocol, heparin exposure and re-exposure did not lower platelet concentration and, therefore, does not appear to be associated with increased risk of HIT in this population.

Supplementary Material