PMID- 22345486 OWN - NLM STAT- MEDLINE DCOM- 20130708 LR - 20121221 IS - 1938-2723 (Electronic) IS - 1076-0296 (Linking) VI - 19 IP - 1 DP - 2013 Jan-Feb TI - Evaluation of circuit and AV fistula clotting and detection of anti-PF4/heparin complex antibodies in hemodialysis patients suspected of having heparin-induced thrombocytopenia. PG - 73-8 LID - 10.1177/1076029612436676 [doi] AB - A retrospective study was performed to elucidate the characteristics of heparin-induced thrombocytopenia (HIT) in newly treated hemodialysis (HD) patients who essentially required anticoagulation with unfractionated heparin (UFH). Seventy-eight patients suspected of having HIT within 3 months of starting HD with UFH were selected for this study. Their platelet counts were routinely followed, and anti-PF4/heparin complex antibodies (HIT antibodies) were measured with enzyme-linked immunosorbent assay (ELISA) until the titer became negative. The characteristics of thrombocytopenia were a platelet count of /=30% and as caused by the intermittent use (3 times/a week) of UFH during HD. Fifty-five patients showed unexpected clotting in the extracorporeal circuit and/or arteriovenous fistula (AVF) thrombosis, while 23 patients had neither of these complications. The patients were classified into HD-related and non-HD-related thrombus groups. The impact of various combinations of the 3 clinical factors (thrombocytopenia, timing, and HD-related thrombus) and the results of ELISA as a laboratory factor were examined. A combination of 2 platelet factors (thrombocytopenia and timing) and ELISA positivity did not reveal the presence of HIT, while a combination of the 3 clinical factors and a positive ELISA improved the accuracy of HIT diagnosis. The findings on the 4-factor combination were supported by high rates of seroconversion in a serotonin release assay. Combining appropriate clinical factors and a positive ELISA may lead to the proper management of HD patients suspected of having HIT. In conclusion, while HD patients showed a drop of /=30% on days 7 to 30, unexpected clotting in the circuit and/or AVF thrombosis was considered as a sign of HIT development. FAU - Matsuo, Takefumi AU - Matsuo T AD - Hyogo Prefectural Awaji Hospital, Sumoto, Hyogo, Japan. tak-matsuo@deluxe.ocn.ne.jp FAU - Wanaka, Keiko AU - Wanaka K FAU - Walenga, Jeanine M AU - Walenga JM LA - eng PT - Clinical Trial PT - Journal Article DEP - 20120216 PL - United States TA - Clin Appl Thromb Hemost JT - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis JID - 9508125 RN - 0 (Anticoagulants) RN - 0 (Autoantibodies) RN - 37270-94-3 (Platelet Factor 4) RN - 9005-49-6 (Heparin) SB - IM MH - Aged MH - Aged, 80 and over MH - Anastomosis, Surgical MH - Anticoagulants/administration & dosage/*adverse effects MH - Autoantibodies/*blood MH - Female MH - Heparin/administration & dosage/*adverse effects MH - Humans MH - Male MH - Middle Aged MH - Platelet Count MH - *Platelet Factor 4 MH - *Renal Dialysis MH - Retrospective Studies MH - Thrombocytopenia/blood/chemically induced/complications MH - *Thrombosis/blood/etiology MH - Time Factors EDAT- 2012/02/22 06:00 MHDA- 2013/07/09 06:00 CRDT- 2012/02/21 06:00 PHST- 2012/02/21 06:00 [entrez] PHST- 2012/02/22 06:00 [pubmed] PHST- 2013/07/09 06:00 [medline] AID - 1076029612436676 [pii] AID - 10.1177/1076029612436676 [doi] PST - ppublish SO - Clin Appl Thromb Hemost. 2013 Jan-Feb;19(1):73-8. doi: 10.1177/1076029612436676. Epub 2012 Feb 16.