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24.09.2019

Comparison of polyspecific versus IgG specific ELISA in predominately cardiac patients with suspected heparin induced thrombocytopenia

Zeitschrift:
Journal of Thrombosis and Thrombolysis
Autoren:
Sophie Samuel, Mary F. McGuire, Jennifer Cortes, Miguel Escobar, Phillip Weeks, Andy Nguyen
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11239-019-01957-z) contains supplementary material, which is available to authorized users.

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Abstract

A diagnosis of heparin induced thrombocytopenia (HIT) must often be made based on clinical and laboratory evidence. This was a quasi-experimental study of patients admitted from June 2016 to October 2017. The primary endpoint was the incidence of false positive results in polyspecific and IgG specific enzyme-linked immunosorbent assay (ELISA); then we compared the sensitivity and specificity of each assays in predominately cardiac patients with suspected HIT. A sensitivity/specificity analysis was conducted using serotonin release assay (SRA) as the ‘gold standard’. The secondary outcome measures included length of hospital stay. We identified a total of 155 patients who met the inclusion criteria. Confirmatory tests with SRA on both groups were completed; false positive result was higher in the polyspecific group when compared to the IgG group [60% vs. 5%]. The IgG specific ELISA test yielded a sensitivity of 100% and a specificity of 95% however, the polyspecific ELISA had a low yield for specificity of 24% but maintained 100% sensitivity. In the IgG specific group with HIT-, their median length of stay was halved compared to those who were HIT + ; hospital LOS in days, IQR [30 (27–81) vs. 15 (7–33) p = 0.023] and a shorter median LOS in the ICU, IQR [24 (5–47) vs. 6 (2–14); p = 0.079]. Hospital or ICU LOS was the same in both (HIT+ and HIT−) groups managed with polyspecific ELISA. The IgG specific test had few false positive results and a high sensitivity score. Ensuring appropriate testing can bring a substantial decrease in drug expenditure, reduced length of stay and prevent unnecessary anticoagulation.

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Zusatzmaterial
Supplementary material 1 (DOC 26 kb)
11239_2019_1957_MOESM1_ESM.doc
Supplementary material 2 (DOC 26 kb)
11239_2019_1957_MOESM2_ESM.doc
Supplementary material 3 (DOC 137 kb)
11239_2019_1957_MOESM3_ESM.doc
Literatur
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