Comparative Analysis of a French Prospective Series of 144 Patients with Heparin-Induced Thrombocytopenia (FRIGTIH) and the Literature

Yves Gruel; Caroline Vayne; Jérôme Rollin; Pierre Weber; Dorothée Faille; Anne Bauters; Laurent Macchi; Martine Alhenc-Gelas; Aurélien Lebreton; Emmanuel De Maistre; Sophie Voisin; Valérie Gouilleux-Gruart; Julien Perrin; Brigitte Tardy-Poncet; Ismail Elalamy; Cécile Lavenu-Bombled; Christine Mouton; Christine Biron; Catherine Ternisien; Fabienne Nedelec-Gac; Jérôme Duchemin; Emmanuelle De Raucourt; Isabelle Gouin-Thibault; Lucia Rugeri; Bernard Tardy; Bruno Giraudeau; Théodora Bejan-Angoulvant; Claire Pouplard

doi:10.1055/s-0040-1712957

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2020; 120(07): 1096-1107
DOI: 10.1055/s-0040-1712957

Cellular Haemostasis and Platelets

Georg Thieme Verlag KG Stuttgart · New York

Comparative Analysis of a French Prospective Series of 144 Patients with Heparin-Induced Thrombocytopenia (FRIGTIH) and the Literature

Yves Gruel

¹EA 7501, GICC, Université de Tours, Tours, France

²Service d'Hématologie-Hémostase, CHRU Tours, Tours, France

,

Caroline Vayne

¹EA 7501, GICC, Université de Tours, Tours, France

²Service d'Hématologie-Hémostase, CHRU Tours, Tours, France

,

Jérôme Rollin

¹EA 7501, GICC, Université de Tours, Tours, France

²Service d'Hématologie-Hémostase, CHRU Tours, Tours, France

,

Pierre Weber

²Service d'Hématologie-Hémostase, CHRU Tours, Tours, France

,

Dorothée Faille

³Laboratoire d'Hématologie, Hôpital Bichat, Paris, France

,

Anne Bauters

⁴Département d'Hémostase et Transfusion, CHU Lille, Lille, France

,

Laurent Macchi

⁵Laboratoire d'Hématologie, CHRU Angers, Angers, France

,

Martine Alhenc-Gelas

⁶Laboratoire d'Hématologie, HEGP Paris, Paris, France

,

Aurélien Lebreton

⁷Laboratoire d'Hématologie, CHRU Clermont-Ferrand, Clermont-Ferrand, France

,

Emmanuel De Maistre

⁸Laboratoire d'Hématologie, CHRU Dijon, Dijon, France

,

Sophie Voisin

⁹Laboratoire d'Hématologie, CHRU Toulouse, Toulouse, France

,

Valérie Gouilleux-Gruart

¹EA 7501, GICC, Université de Tours, Tours, France

¹⁰Laboratoire d'Immunologie, CHRU Tours, Tours, France

,

Julien Perrin

¹¹Laboratoire d'Hématologie, CHRU Nancy, Nancy, France

,

Brigitte Tardy-Poncet

¹²Laboratoire d'Hématologie, CHRU Saint-Etienne, Saint-Etienne, France

,

Ismail Elalamy

¹³Laboratoire d'Hématologie, Hôpital Tenon, Paris, France

,

Cécile Lavenu-Bombled

¹⁴Laboratoire d'Hématologie, Hôpital Henri Mondor, Créteil, France

,

Christine Mouton

¹⁵Laboratoire d'Hématologie, CHRU Bordeaux, Bordeaux, France

,

Christine Biron

¹⁶Laboratoire d'Hématologie, CHRU Montpellier, Montpellier, France

,

Catherine Ternisien

¹⁷Laboratoire d'Hématologie, CHRU Nantes, Nantes, France

,

Fabienne Nedelec-Gac

¹⁸Laboratoire d'Hématologie, CHRU Rennes, Rennes, France

,

Jérôme Duchemin

¹⁹Laboratoire d'Hématologie, CHRU Poitiers, Poitiers, France

,

Emmanuelle De Raucourt

²⁰Laboratoire d'Hématologie, Hopital Beaujon, Clichy, France

,

Isabelle Gouin-Thibault

²¹Laboratoire d'Hématologie, Hopital Cochin, Paris, France

,

Lucia Rugeri

²²Laboratoire d'Hématologie, CHRU Lyon, Lyon, France

,

Bernard Tardy

²³INSERM CIC 1408, Unité de soins intensifs, CHRU Saint-Etienne, Saint-Etienne, France

,

Bruno Giraudeau

²⁴INSERM CIC, CHRU Tours, Tours, France

,

Théodora Bejan-Angoulvant

¹EA 7501, GICC, Université de Tours, Tours, France

²⁵Département de Pharmacologie Médicale, CHRU Tours, Tours, France

,

Claire Pouplard

¹EA 7501, GICC, Université de Tours, Tours, France

²Service d'Hématologie-Hémostase, CHRU Tours, Tours, France

› Institutsangaben

Abstract

Background Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatments, and only a few large patient cohorts have been reported. In this study, biological and clinical data from 144 French patients with HIT were analyzed in comparison with the literature.

Methods The diagnosis of HIT was confirmed in all patients by an immunoassay combined with serotonin release assay. In the literature, only cohorts of at least 20 HIT patients published from 1992 were selected for a comparative analysis.

Results Two-thirds of patients were hospitalized in surgery and most were treated with unfractionated heparin (83.2% vs. 16.8% with low molecular weight heparin only). Thrombotic events in 54 patients (39.7%) were mainly venous (41/54). However, arterial thrombosis was more frequent after cardiac surgery (13.2% vs. 2.4% in other surgeries, p = 0.042) with a shorter recovery time (median = 3 vs. 5 days, p < 0.001). The mortality rate was lower in our series than in the 22 selected published studies (median = 6.3% vs. 15.9%). Three genetic polymorphisms were also studied and homozygous subjects FcγRIIA RR were more frequent in patients with thrombosis (37.8 vs. 18.2% in those without thrombosis, p = 0.03).

Conclusion This study shows that the mortality rate due to HIT has recently decreased in France, possibly due to earlier diagnosis and improved medical care. It also confirms the strong association between polymorphism FcγRIIA H131R and thrombosis in HIT.

Keywords

heparin - thrombocytopenia - thrombosis

Volltext

Referenzen

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