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Heparin-Induced Thrombocytopenia in the ICUICU Diagnosis of Heparin-Induced Thrombocytopenia: A Transatlantic Perspective

Theodore E. Warkentin, MD; PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group
Author and Funding Information

From the Department of Pathology and Molecular Medicine, and Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University; Hamilton Regional Laboratory Medicine Program; and Hamilton Health Sciences, Hamilton General Hospital.

Correspondence to: Theodore (Ted) E. Warkentin, MD, Hamilton Regional Laboratory Medicine Program, Room 1-270B, Hamilton Health Sciences, Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada; e-mail: twarken@mcmaster.ca


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Warkentin has received lecture honoraria from Pfizer Canada and Sanofi-Aventis and royalties from Informa, plc; has provided consulting services to and/or has received research funding from Canyon Pharmaceuticals, GlaxoSmithKline, ParinGenix, Inc, and W. L. Gore & Associates, Inc; and has provided expert witness testimony relating to HIT.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):815-816. doi:10.1378/chest.12-0979
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In this issue of CHEST (see page 837), Trehel-Tursis and colleagues1 from France report their 6-year study (ending December 2010) of heparin-induced thrombocytopenia (HIT) occurring in a cardiothoracic surgery ICU. During this time, nearly 6,000 patients entered their ICU: 46% postcardiac surgery, 9% postcarotid endarterectomy, and 45% postthoracic surgery; 101 of 5,949 patients (1.7%) were suspected of possibly having HIT. All patients with suspected HIT were investigated by a polyspecific anti-PF4/heparin enzyme-linked immunosorbent assay (ELISA) that detects IgG, IgA, and IgM class antibodies. In about 90% of patients, additional testing was performed using a functional (platelet activation) assay, either a platelet aggregation test (PAT) or the serotonin release assay (SRA), or both. With few exceptions, patients were considered to have HIT if they tested positive in both the ELISA and one of the functional assays.

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