Incidence and mortality of heparin-induced thrombocytopenia in critically Ill patients.

OBJECTIVES

Heparin is widely used as an anticoagulant in hospitals. Ventilated patients on heparin are at a higher risk of developing heparin-induced thrombocytopenia (HIT). This study aims to examine the effect of HIT on mortality in ventilated patients.

METHODS

We used available ICD-10 codes from 2016 to 2020. Patients with specific ICD-10 codes for HIT and ventilator dependence were included. The incidence of HIT in ventilated patients was calculated, and mortality rates were compared between HIT-positive and HIT-negative ventilated patients. For the year 2020, given the presence of COVID, additional multivariate analysis was performed to adjust for baseline characteristics and confounding factors.

RESULTS

We found no significant increase in mortality in patients on ventilation with HIT compared to those without HIT for the years 2016-2019 in the pre-COVID era. However, there was a significant increase in mortality among ventilated patients with HIT in the year 2020 during the first year of the COVID pandemic before vaccination (odds ratio [OR] = 2.03, 95% confidence interval [CI] = 1.26-3.26, P = 0.004). However, after adjusting for age, gender, race, and COVID-19 diagnosis, only COVID-19, but not HIT, showed a significantly higher risk of mortality in ventilated patients with HIT compared to no HIT (OR = 3.80, 95% CI = 3.47-4.15, P < 0.001).

CONCLUSIONS

These findings suggest HIT is not associated with increased mortality among ventilated patients. However, in the year 2020, COVID-19 infection increased the mortality of ventilated patients by almost 4-fold regardless of HIT. This data suggests that HIT is not an independent risk for mortality in ventilated patients.