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

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