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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
1   EA 7501, GICC, Université de Tours, Tours, France
2   Service d'Hématologie-Hémostase, CHRU Tours, Tours, France
,
Caroline Vayne
1   EA 7501, GICC, Université de Tours, Tours, France
2   Service d'Hématologie-Hémostase, CHRU Tours, Tours, France
,
Jérôme Rollin
1   EA 7501, GICC, Université de Tours, Tours, France
2   Service d'Hématologie-Hémostase, CHRU Tours, Tours, France
,
Pierre Weber
2   Service d'Hématologie-Hémostase, CHRU Tours, Tours, France
,
Dorothée Faille
3   Laboratoire d'Hématologie, Hôpital Bichat, Paris, France
,
Anne Bauters
4   Département d'Hémostase et Transfusion, CHU Lille, Lille, France
,
Laurent Macchi
5   Laboratoire d'Hématologie, CHRU Angers, Angers, France
,
Martine Alhenc-Gelas
6   Laboratoire d'Hématologie, HEGP Paris, Paris, France
,
Aurélien Lebreton 
7   Laboratoire d'Hématologie, CHRU Clermont-Ferrand, Clermont-Ferrand, France
,
Emmanuel De Maistre
8   Laboratoire d'Hématologie, CHRU Dijon, Dijon, France
,
Sophie Voisin
9   Laboratoire d'Hématologie, CHRU Toulouse, Toulouse, France
,
Valérie Gouilleux-Gruart
1   EA 7501, GICC, Université de Tours, Tours, France
10   Laboratoire d'Immunologie, CHRU Tours, Tours, France
,
Julien Perrin
11   Laboratoire d'Hématologie, CHRU Nancy, Nancy, France
,
Brigitte Tardy-Poncet
12   Laboratoire d'Hématologie, CHRU Saint-Etienne, Saint-Etienne, France
,
Ismail Elalamy
13   Laboratoire d'Hématologie, Hôpital Tenon, Paris, France
,
Cécile Lavenu-Bombled
14   Laboratoire d'Hématologie, Hôpital Henri Mondor, Créteil, France
,
Christine Mouton
15   Laboratoire d'Hématologie, CHRU Bordeaux, Bordeaux, France
,
Christine Biron
16   Laboratoire d'Hématologie, CHRU Montpellier, Montpellier, France
,
Catherine Ternisien
17   Laboratoire d'Hématologie, CHRU Nantes, Nantes, France
,
Fabienne Nedelec-Gac
18   Laboratoire d'Hématologie, CHRU Rennes, Rennes, France
,
Jérôme Duchemin
19   Laboratoire d'Hématologie, CHRU Poitiers, Poitiers, France
,
Emmanuelle De Raucourt
20   Laboratoire d'Hématologie, Hopital Beaujon, Clichy, France
,
Isabelle Gouin-Thibault
21   Laboratoire d'Hématologie, Hopital Cochin, Paris, France
,
Lucia Rugeri
22   Laboratoire d'Hématologie, CHRU Lyon, Lyon, France
,
Bernard Tardy
23   INSERM CIC 1408, Unité de soins intensifs, CHRU Saint-Etienne, Saint-Etienne, France
,
Bruno Giraudeau
24   INSERM CIC, CHRU Tours, Tours, France
,
Théodora Bejan-Angoulvant
1   EA 7501, GICC, Université de Tours, Tours, France
25   Département de Pharmacologie Médicale, CHRU Tours, Tours, France
,
Claire Pouplard
1   EA 7501, GICC, Université de Tours, Tours, France
2   Service d'Hématologie-Hémostase, CHRU Tours, Tours, France
› Author Affiliations Funding The project FRIGTIH was supported by a PHRC grant (PHRN09-YG/FRIGTIH) and by the IRTH (Institut pour la Recherche sur la Thrombose et l'Hémostase).
Further Information

Publication History

09 January 2020

23 April 2020

Publication Date:
22 June 2020 (online)

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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

Authors' Contributions

Y.G. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Y.G., B.G., and C.P. designed the research, C.V., J.R., and P.V. performed the research, Y.G., D.F., A.B., L.A., M.A.G., A.L., E.D.M., S.V., B.T., B.T.P., J.P., I.E., S.D., C.L.B., C.M., M.W., C.B., C.T., F.N., P.G., J.D., L.R., E.D.R., I.G.T., and C.P. provided patients samples and clinical follow-up. Y.G., C.V., J.R., P.V., B.G., T.B.A., and C.P. analyzed the data. Y.G. and C.P. supervised the study and wrote the paper.


Supplementary Material

 

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