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Introduction <p>Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder with potential bleeding complications, yet data from Asian populations are scarce.</p> Objectives <p>Our study aims to determine bleeding and thrombotic incidence and identify associated factors in Thai HIT patients.</p> Methods <p>We retrospectively and prospectively studied patients with suspected or confirmed HIT at Siriraj Hospital (January 2004‒December 2024). Fondaparinux was the sole non-heparin anticoagulant. Suspected HIT required a positive immunoassay or platelet aggregation test.</p> Results <p>Forty-one patients (mean age, 66.8 years) were included, of whom 33 had confirmed HIT. Five had thrombosis, 16 (39%) required intensive-care-unit admission, and 29 (70.7%) had renal impairment. Among these 29, 13 developed new-onset acute kidney injury, and 16 had pre-existing renal disease (14 progressed to acute kidney injury). Most received fondaparinux (<i>n</i> = 25), whereas 5 received regional citrate, 1 warfarin, and 10 no anticoagulation. Overall mortality was 29.3%. One non-anticoagulated patient developed pulmonary embolism. Bleeding incidence was 1.22% per day, affecting 11 patients (26.8%), of whom 10 had renal impairment and 7 met International Society on Thrombosis and Haemostasis criteria for major bleeding. Bleeding rates did not differ between confirmed and suspected HIT (24.2% vs. 37.5%; <i>P</i> = .658). Pre-existing chronic kidney disease (hazard ratio, 2.78; 95% CI, 0.84‒9.26; <i>P</i> = .095) and sustained low-efficiency dialysis (hazard ratio, 4.60; 95% CI, 1.50‒14.09; <i>P</i> = .008) were associated with bleeding.</p> Conclusions <p>In this Thai cohort, HIT conferred a high bleeding risk, especially in patients with renal impairment. These findings underscore the need for renal-safe non-heparin anticoagulants in resource-limited settings.</p> Trial registration <p>TCTR20241227001.</p>

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Bleeding and thrombotic events in patients with heparin-induced thrombocytopenia: a two-decade single-center experience in Thailand

  • 期刊论文

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  • 发表日期：

    2025年11月3日

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  • Yotsathon Chantarawichian,
  • Bundarika Suwanawiboon,
  • Theera Ruchutrakool,
  • Yingyong Chinthammitr,
  • Tarinee Rungjirajittranon

摘要

Introduction

Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder with potential bleeding complications, yet data from Asian populations are scarce.

Objectives

Our study aims to determine bleeding and thrombotic incidence and identify associated factors in Thai HIT patients.

Methods

We retrospectively and prospectively studied patients with suspected or confirmed HIT at Siriraj Hospital (January 2004‒December 2024). Fondaparinux was the sole non-heparin anticoagulant. Suspected HIT required a positive immunoassay or platelet aggregation test.

Results

Forty-one patients (mean age, 66.8 years) were included, of whom 33 had confirmed HIT. Five had thrombosis, 16 (39%) required intensive-care-unit admission, and 29 (70.7%) had renal impairment. Among these 29, 13 developed new-onset acute kidney injury, and 16 had pre-existing renal disease (14 progressed to acute kidney injury). Most received fondaparinux (n = 25), whereas 5 received regional citrate, 1 warfarin, and 10 no anticoagulation. Overall mortality was 29.3%. One non-anticoagulated patient developed pulmonary embolism. Bleeding incidence was 1.22% per day, affecting 11 patients (26.8%), of whom 10 had renal impairment and 7 met International Society on Thrombosis and Haemostasis criteria for major bleeding. Bleeding rates did not differ between confirmed and suspected HIT (24.2% vs. 37.5%; P = .658). Pre-existing chronic kidney disease (hazard ratio, 2.78; 95% CI, 0.84‒9.26; P = .095) and sustained low-efficiency dialysis (hazard ratio, 4.60; 95% CI, 1.50‒14.09; P = .008) were associated with bleeding.

Conclusions

In this Thai cohort, HIT conferred a high bleeding risk, especially in patients with renal impairment. These findings underscore the need for renal-safe non-heparin anticoagulants in resource-limited settings.

Trial registration

TCTR20241227001.