Pishko et al identified risk factors for major bleeding in a patient with suspected heparin-induced thrombocytopenia (HIT). These can help to identify a patient who may require more aggressive management. The authors are from the University of Pennsylvania, Tufts Medical Center, Duke University, McMaster University, Weill Cornell Medical College and Children's Hospital of Philadelphia.
Patient selection: suspected heparin-induced thrombocytopenia (15% HIT positive on testiing)
Risk factors for major bleeding:
(1) admission to the ICU (odds ratio 2.2)
(2) platelet count < 25 * 10^9/L (< 25,000 per µL; odds ratio 2.1)
(3) renal dysfunction (odds ratio 1.6)
Outcomes:
(1) major bleeding (around 40%, based on ISTH criteria)
(2) new or progressive thrombosis (36% if HIT positive; 9-14% if HIT negative)
(3) mortality (around 30%)
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