Use of therapeutic plasma exchange in heparin-induced thrombocytopenia: A population-based study.

Abstract

Background

Heparin-induced thrombocytopenia (HIT) is characterized by anti-heparin/platelet factor 4 immune complexes, which are removed by therapeutic plasma exchange (TPE). Our main objective was to study TPE outcomes in HIT using a large administrative claims database.

Study design and methods

We used the National Inpatient Sample (NIS) to identify hospital discharges of adult patients (≥18) with a primary or secondary diagnosis of HIT. Cases were classified into two groups based on TPE use. The primary outcome was in-hospital mortality. Secondary outcomes were thrombotic events, major bleeding, hospital length of stay (LOS), and charges. Multivariable regression analysis, controlling for age and medical comorbidities, was used to examine the association of TPE with study outcomes.

Results

A HIT diagnosis was made in 22 165 discharges, of which 90 (0.4%) received TPE. Corresponding national estimates are 106 435 and 439, respectively. TPE was not associated with decreased in-hospital mortality (OR = 1.72; 95%CI: 0.93-3.17, P = .085). However, TPE was associated with a higher likelihood of major bleeding (OR = 2.35; 95%CI: 1.40-3.68, P = .0009), primarily driven by gastrointestinal bleeding (OR = 2.21; 95%CI: 1.17-4.17, P = .015). TPE was also associated with higher hospital LOS (20.5 vs 10 day, P < .0001) and charges (USD 211181 vs USD 81654, P < .0001).

Conclusion

TPE's association with increased bleeding and a prolonged hospital course indicates that it is being used in HIT cases with a severe clinical phenotype. Future studies are needed to better characterize the HIT phenotype that will most benefit from TPE.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1002/jca.21876

Publication Info

Soares Ferreira Júnior, Alexandre, Stephen H Boyle, Maragatha Kuchibhatla, Tomi Akinyemiju and Oluwatoyosi A Onwuemene (2021). Use of therapeutic plasma exchange in heparin-induced thrombocytopenia: A population-based study. Journal of clinical apheresis, 36(3). pp. 398–407. 10.1002/jca.21876 Retrieved from https://hdl.handle.net/10161/27010.

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Scholars@Duke

Boyle

Stephen H Boyle

Medical Instructor in the Department of Psychiatry and Behavioral Sciences

One focus of my research has been to identity psychosocial factors that predict the development of CHD and disease progression among patients with established CHD. This research has considered the roles of both negative (e.g. anger, hostility, depressive symptoms, anxiety) and positive (i.e. positive emotion, Openness to Experience, recovery expectations) dispositions. My research has also focused on delineating mechanisms that underlie the associations between psychosocial factors and coronary health. This includes studies of markers of inflammation, glucose metabolism, cortisol, lipids, alcohol consumption patterns, and mental stress induced myocardial ischemia. One important observation from this research is that mechanisms mediating stress-disease associations appear to be complex involving multiple behavioral and physiological pathways.

Kuchibhatla

Maragatha Kuchibhatla

Professor of Biostatistics & Bioinformatics

Statistical research methodology, analysis of repeated measurements, latent growth curve models, latent class growth models, classification and regression trees,
designing clinical trials, designing clinical trials in psychiatry -- both treatment and non-treatment
trials in various comorbid populations.

Akinyemiju

Tomi Akinyemiju

Professor in Population Health Sciences

Area of Expertise: Epidemiology

Dr. Akinyemiju is a Professor of Population Health Sciences, Global Health and Ob/Gyn with expertise in cancer epidemiology, cancer biology, global health, and health disparities.  Her research expertise and accomplishments have focused on articulating and innovating conceptual and empirical approaches for cancer health disparities research, specifically, disentangling the role of race as a social construct and race-associated biological mechanisms that contribute to cancer disparities. Dr. Akinyemiju also serves as the Vice-Chair for Diversity, Equity, and Inclusion at the Department of Population Health Sciences, and Associate Director for Community Outreach, Engagement, and Equity at the Duke Cancer Institute. Dr. Akinyemiju’s leadership centers around building cross-enterprise, multi-stakeholder coalitions to advance health equity, promote inclusion and diversity, and mentor the next generation of diverse, talented clinical research scholars. Dr. Akinyemiju has received numerous awards, including the 2023 Michelle Winn Inclusive Excellence Award

Dr. Akinyemiju has published over 150 peer-reviewed publications, and her research program has been continuously funded by the National Institutes of Health, Susan G. Komen and the V Foundation. She has mentored (formally and informally) at least 50 trainees and junior faculty, over 50% of whom are URM. Dr. Akinyemiju works extensively with diverse stakeholders, including community-based organizations, policy makers, providers, health system leadership, and leaders from diverse communities to develop impactful, evidence-based interventions to advance health equity 

Onwuemene

Oluwatoyosi Adefunke Onwuemene

Associate Professor of Medicine

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