Theodore E. Warkentin, MD The American Journal of Medicine

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Presentation transcript:

Optical Densities Reduce Odds of Heparin-induced Thrombocytopenia Over-diagnosis Theodore E. Warkentin, MD The American Journal of Medicine Volume 125, Issue 1, Pages 3-4 (January 2012) DOI: 10.1016/j.amjmed.2011.10.001 Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure Iceberg model of heparin-induced thrombocytopenia: higher optical density (OD) values in enzyme-immunoassays (EIAs) predict for greater frequency of platelet-activating antibodies, heparin-induced thrombocytopenia (HIT), and HIT-associated thrombosis. Clinically evident heparin-induced thrombocytopenia, comprising patients with (HIT-T) and without thrombosis, is represented by the portion of the iceberg above the waterline; the portion below the waterline represents subclinical anti-platelet factor 4 (PF4)/heparin seroconversion. Three types of assays are highly sensitive for diagnosis of heparin-induced thrombocytopenia: the platelet activation assay (eg, serotonin-release assay [SRA]), the immunoglobulin G (IgG)-specific PF4-dependent EIAs (EIA-IgG), and polyspecific EIAs that detects anti-PF4/heparin antibodies of the 3 major immunoglobulin classes (EIA-IgG/A/M). In contrast, diagnostic specificity is highest for the SRA, intermediate for the EIA-IgG, and lowest for the EIA-IgG/A/M. The approximate probability of SRA+ status and thrombosis risk—in relation to a given EIA result, expressed in units of optical density—is obtained from the literature.3,5 Presumably, the “background” thrombosis rate for an optical density <0.40 units would be close to ∼15% (not reported by Baroletti et al5). The American Journal of Medicine 2012 125, 3-4DOI: (10.1016/j.amjmed.2011.10.001) Copyright © 2012 Elsevier Inc. Terms and Conditions