Heparin-induced thrombocytopenia epidemiology and demographics: Difference between revisions

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==Overview==
==Overview==
[[Heparin-induced thrombocytopenia]] (HIT) occurs in persons who are exposed to heparin or heparin-related products. The majority of medically or surgically hospitalized patients are exposure to heparin in some form, so the incidence of HIT can be quite high in these persons. The incidence of HIT is higher with certain type of heparin (such as bovine instead of porcine heparin) and in certain types of patients (such as surgical patients instead of obstetric or pediatric patients). There are no geographic or racial disparities in HIT, but it is known that HIT occurs more commonly in females compared to males.
Worldwide, the [[prevalence]] of HIT (in persons exposed to [[heparin]]) ranges from a low of 200 per 100,000 persons to a high of 5,000 per 100,000 persons. In pediatric populations, the prevalence of HIT (in persons exposed to [[heparin]]) ranges from a low of 1,500 per 100,000 persons to a high of 3,700 per 100,000 persons with an average prevalence of 2,600 per 100,000 persons. In [[neonatal]] populations, the prevalence of HIT (in persons exposed to [[heparin]]) is as low as 330 per 100,000 persons. HIT is more prevalent in the African American race than the Caucasian race and occurs more commonly in females compared to males.


==Epidemiology and demographics==
==Epidemiology and demographics==
===Prevalence===
===Prevalence===
*Worldwide, the prevalence of HIT ranges from a low of 200 per 100,000 persons to a high of 3,000 per 100,000 persons.<ref name="pmid20059332">{{cite journal| author=Arepally GM, Ortel TL| title=Heparin-induced thrombocytopenia. | journal=Annu Rev Med | year= 2010 | volume= 61 | issue=  | pages= 77-90 | pmid=20059332 | doi=10.1146/annurev.med.042808.171814 | pmc=4153429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20059332  }} </ref>
*Worldwide, the [[prevalence]] of HIT (in persons exposed to [[heparin]]) ranges from a low of 200 per 100,000 persons to a high of 5,000 per 100,000 persons.<ref name="pmid20059332">{{cite journal| author=Arepally GM, Ortel TL| title=Heparin-induced thrombocytopenia. | journal=Annu Rev Med | year= 2010 | volume= 61 | issue=  | pages= 77-90 | pmid=20059332 | doi=10.1146/annurev.med.042808.171814 | pmc=4153429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20059332 }} </ref><ref name="pmid25444534">{{cite journal| author=Obeng EA, Harney KM, Moniz T, Arnold A, Neufeld EJ, Trenor CC| title=Pediatric heparin-induced thrombocytopenia: prevalence, thrombotic risk, and application of the 4Ts scoring system. | journal=J Pediatr | year= 2015 | volume= 166 | issue= 1 | pages= 144-50 | pmid=25444534 | doi=10.1016/j.jpeds.2014.09.017 | pmc=4274245 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25444534 }} </ref>
**In developed countries, the prevalence of (insert disease state here) ranges from a low of _____ per 100,000 persons to a high of _____ per 100,000 persons with an average prevalence of _____ per 100,000 persons.
*In pediatric populations, the [[prevalence]] of HIT (in persons exposed to [[heparin]]) ranges from a low of 1,500 per 100,000 persons to a high of 3,700 per 100,000 persons with an average prevalence of 2,600 per 100,000 persons.<ref name="pmid25444534">{{cite journal| author=Obeng EA, Harney KM, Moniz T, Arnold A, Neufeld EJ, Trenor CC| title=Pediatric heparin-induced thrombocytopenia: prevalence, thrombotic risk, and application of the 4Ts scoring system. | journal=J Pediatr | year= 2015 | volume= 166 | issue= 1 | pages= 144-50 | pmid=25444534 | doi=10.1016/j.jpeds.2014.09.017 | pmc=4274245 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25444534  }} </ref> The prevalence is 1-3% in children exposed to [[unfractionated heparin]] and undergoing [[cardiac surgery]].<ref name="pmid23118656">{{cite journal| author=Vakil NH, Kanaan AO, Donovan JL| title=Heparin-induced thrombocytopenia in the pediatric population: a review of current literature. | journal=J Pediatr Pharmacol Ther | year= 2012 | volume= 17 | issue= 1 | pages= 12-30 | pmid=23118656 | doi=10.5863/1551-6776-17.1.12 | pmc=3428184 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23118656 }} </ref>
**In developed countries, the prevalence of (insert disease state here) is _____ per 100,000 persons.
*In neonatal populations, the [[prevalence]] of HIT (in persons exposed to [[heparin]]) is as low as 330 per 100,000 persons.<ref name="pmid25444534">{{cite journal| author=Obeng EA, Harney KM, Moniz T, Arnold A, Neufeld EJ, Trenor CC| title=Pediatric heparin-induced thrombocytopenia: prevalence, thrombotic risk, and application of the 4Ts scoring system. | journal=J Pediatr | year= 2015 | volume= 166 | issue= 1 | pages= 144-50 | pmid=25444534 | doi=10.1016/j.jpeds.2014.09.017 | pmc=4274245 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25444534  }} </ref>
**In developing countries/ Africa, the prevalence of (insert disease state here) ranges from a low of _____ per 100,000 persons to a high of _____ per 100,000 persons with an average prevalence of _____ per 100,000 persons.
**In developing countries/ Africa, the prevalence of (insert disease state here) is _____ per 100,000 persons.
**In ____ (insert year), the prevalence of _______ (insert disease name) was estimated to be _______ (insert number) cases per 100,000 individuals worldwide.


===Incidence===
===Case Fatality Rate===
* Incidence is defined as the number of new cases per population in a given time period.
*The [[case fatality rate]] of HIT is 20-30% for patients who develop [[thrombosis]].<ref name="pmid16202170">{{cite journal| author=Franchini M| title=Heparin-induced thrombocytopenia: an update. | journal=Thromb J | year= 2005 | volume= 3 | issue=  | pages= 14 | pmid=16202170 | doi=10.1186/1477-9560-3-14 | pmc=1262784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16202170 }} </ref>
*The standard format to report the incidence is ___ per 100,000 individuals.
*For patients who have HIT but do not develop [[thrombosis]], the case [[fatality rate]] is unknown but is lower than 20-30%.<ref name="pmid16202170">{{cite journal| author=Franchini M| title=Heparin-induced thrombocytopenia: an update. | journal=Thromb J | year= 2005 | volume= 3 | issue=  | pages= 14 | pmid=16202170 | doi=10.1186/1477-9560-3-14 | pmc=1262784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16202170  }} </ref>
*When using numbers with decimal points, avoid reporting more than 1 number after the decimal point. For example, report a incidence as 10.1 instead of 10.09322. Many numbers after the decimal point may suggest a false sense of accuracy.
* You can pick one or more of the template sentences below for this section:
**Worldwide, the incidence of (insert disease state here) ranges from a low of _____ per 100,000 persons to a high of _____ per 100,000 persons with an average incidence of _____ per 100,000 persons.
**Worldwide, the incidence of (insert disease state here) is _____ per 100,000 persons.
**In developed countries, the incidence of (insert disease state here) ranges from a low of _____ per 100,000 persons  to a high of _____ per 100,000 persons with an average incidence of _____ per 100,000 persons.
**In developed countries, the incidence of (insert disease state here) is _____ per 100,000 persons.
**In developing countries/ Africa, the incidence of (insert disease state here) ranges from a low of _____ per 100,000 persons  to a high of _____ per 100,000 persons with an average incidence of _____ per 100,000 persons.
**In developing countries/ Africa, the incidence of (insert disease state here) is _____ per 100,000 persons.
**In ____ (insert year), the incidence of _______ (insert disease name) was estimated to be _______ (insert number) cases per 100,000 individuals worldwide.


===Case Fatality Rate===
*The case fatality rate is defined the number of deaths (fatality) among patients with the disease (case). Case fatality rate should be distinguished from "Mortality Rate" (defined as the number of deaths among the at-risk population).
*The case fatality rate is usually described as a function of time (e.g. In 2015 / annually etc...).
*When using numbers with decimal points, avoid reporting more than 1 number after the decimal point. For example, report the case fatality rate as 10.1% instead of 10.09322%. Many numbers after the decimal point may suggest a false sense of accuracy.
*You can pick the template sentence below for this section:
**In ____ (year), the case fatality rate of ____ (disease name) is ____ (case fatality rate in %).
**The annual case fatality rate of ____ (disease name) is approximately ____ (case fatality rate in %).
===Age===
===Age===
*This section can describe the impact of the disease depending on the persons age, and the age-specific prevalence and incidence.
*The adult population is more prone to development of HIT than the [[Pediatrics|pediatric]] population. Please see the Prevalence section above for the [[prevalence]] of HIT in pediatric and [[neonatal]] populations.
*The prevalence of ____ (insert disease state here) increases/decreases with age.
*_____ (insert acute disease) commonly affects _____ (insert age group).
*_____ (insert chronic disease) is usually first diagnosed among _____ (insert age group).


===Gender===
===Gender===
This section describe how prevalence of the disease varies by gender.
*Females are more commonly affected with HIT than males. The female to male ratio is approximately 2.4 to 1.<ref name="pmid23714311">{{cite journal| author=Lee GM, Arepally GM| title=Diagnosis and management of heparin-induced thrombocytopenia. | journal=Hematol Oncol Clin North Am | year= 2013 | volume= 27 | issue= 3 | pages= 541-63 | pmid=23714311 | doi=10.1016/j.hoc.2013.02.001 | pmc=3668315 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23714311  }} </ref> This is thought to be related to higher predilection for [[autoimmune]] tendencies in females compared to males.
When describing male to female ratios with decimal points, avoid reporting more than 1 number after the decimal point. For example, report a ratio as as 1.5 to 1 instead of 1.48294 to 1. Many numbers after the decimal point may suggest a false sense of accuracy.
You can use either of the following template sentences:
* ______ (insert gender 1) are more commonly affected with ______ (insert disease name) than _____ (insert gender 2). The _____ (insert gender ratio e.g. male to female) ratio is approximately _____ (insert number > 1) to 1.
* The prevalence and incidence of (insert disease state here) does not vary by gender.
* Men and women are affected equally by (insert disease name here).
* (Insert disease state here) is more prevalent in men  women.
* The prevalence of (insert disease state here) among men is ____ per 100,000, while it is _____ per 100,000 among women.
* The incidence of (insert disease state here) among men is ____ per 100,000, while it is _____ per 100,000 among women.


===Race===
===Race===
This section describes how the disease differs based upon race.
*HIT is more prevalent in the African American race than the Caucasian race.<ref name="pmid23714311">{{cite journal| author=Lee GM, Arepally GM| title=Diagnosis and management of heparin-induced thrombocytopenia. | journal=Hematol Oncol Clin North Am | year= 2013 | volume= 27 | issue= 3 | pages= 541-63 | pmid=23714311 | doi=10.1016/j.hoc.2013.02.001 | pmc=3668315 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23714311  }} </ref>
You can use the following template sentence for this section:
 
* The prevalence of _____ (insert disease) does not vary by race.
* (Insert disease state here) is more prevalent in the ____ (inser race) race and ____ (insert other race) races.
*There is no racial predilection for ____ (insert disease name)
* _____ (insert disease) usually affects individuals of the _____ (inser race) race. _____ (insert other race) individuals are less likely to develop ______ (disease name).
===Developed Countries===
===Developed Countries===
* In this section you should describe the impact of the disease in developed countries.
HIT has a major impact on society in developed countries. Development of HIT can lead to high [[morbidity]] and [[mortality]] in hospitals and can increase health care costs. For example, the development of [[thrombotic]] complications can lead to the need for prolonged [[Anticoagulant|anticoagulation]] and monitoring, which places a burden on the healthcare system.
* Incidence, prevalence, and geographical distribution or areas of interest can be mentioned, as well as the relevant impact the disease has on society.


===Developing Countries===
===Developing Countries===
* In this section you should describe the impact of the disease in developing countries.
There is minimal data on HIT in developing countries. There is no variation in [[prevalence]] of HIT in developing countries.
* Incidence, prevalence, and geographical distribution or areas of interest can be mentioned, as well as the relevant impact the disease has on society.


==Reference==
==Reference==

Latest revision as of 15:07, 8 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2] Shyam Patel [3]

Overview

Worldwide, the prevalence of HIT (in persons exposed to heparin) ranges from a low of 200 per 100,000 persons to a high of 5,000 per 100,000 persons. In pediatric populations, the prevalence of HIT (in persons exposed to heparin) ranges from a low of 1,500 per 100,000 persons to a high of 3,700 per 100,000 persons with an average prevalence of 2,600 per 100,000 persons. In neonatal populations, the prevalence of HIT (in persons exposed to heparin) is as low as 330 per 100,000 persons. HIT is more prevalent in the African American race than the Caucasian race and occurs more commonly in females compared to males.

Epidemiology and demographics

Prevalence

  • Worldwide, the prevalence of HIT (in persons exposed to heparin) ranges from a low of 200 per 100,000 persons to a high of 5,000 per 100,000 persons.[1][2]
  • In pediatric populations, the prevalence of HIT (in persons exposed to heparin) ranges from a low of 1,500 per 100,000 persons to a high of 3,700 per 100,000 persons with an average prevalence of 2,600 per 100,000 persons.[2] The prevalence is 1-3% in children exposed to unfractionated heparin and undergoing cardiac surgery.[3]
  • In neonatal populations, the prevalence of HIT (in persons exposed to heparin) is as low as 330 per 100,000 persons.[2]

Case Fatality Rate

Age

  • The adult population is more prone to development of HIT than the pediatric population. Please see the Prevalence section above for the prevalence of HIT in pediatric and neonatal populations.

Gender

  • Females are more commonly affected with HIT than males. The female to male ratio is approximately 2.4 to 1.[5] This is thought to be related to higher predilection for autoimmune tendencies in females compared to males.

Race

  • HIT is more prevalent in the African American race than the Caucasian race.[5]

Developed Countries

HIT has a major impact on society in developed countries. Development of HIT can lead to high morbidity and mortality in hospitals and can increase health care costs. For example, the development of thrombotic complications can lead to the need for prolonged anticoagulation and monitoring, which places a burden on the healthcare system.

Developing Countries

There is minimal data on HIT in developing countries. There is no variation in prevalence of HIT in developing countries.

Reference

  1. ↑ Arepally GM, Ortel TL (2010). "Heparin-induced thrombocytopenia". Annu Rev Med. 61: 77–90. doi:10.1146/annurev.med.042808.171814. PMC 4153429. PMID 20059332.
  2. ↑ 2.0 2.1 2.2 Obeng EA, Harney KM, Moniz T, Arnold A, Neufeld EJ, Trenor CC (2015). "Pediatric heparin-induced thrombocytopenia: prevalence, thrombotic risk, and application of the 4Ts scoring system". J Pediatr. 166 (1): 144–50. doi:10.1016/j.jpeds.2014.09.017. PMC 4274245. PMID 25444534.
  3. ↑ Vakil NH, Kanaan AO, Donovan JL (2012). "Heparin-induced thrombocytopenia in the pediatric population: a review of current literature". J Pediatr Pharmacol Ther. 17 (1): 12–30. doi:10.5863/1551-6776-17.1.12. PMC 3428184. PMID 23118656.
  4. ↑ 4.0 4.1 Franchini M (2005). "Heparin-induced thrombocytopenia: an update". Thromb J. 3: 14. doi:10.1186/1477-9560-3-14. PMC 1262784. PMID 16202170.
  5. ↑ 5.0 5.1 Lee GM, Arepally GM (2013). "Diagnosis and management of heparin-induced thrombocytopenia". Hematol Oncol Clin North Am. 27 (3): 541–63. doi:10.1016/j.hoc.2013.02.001. PMC 3668315. PMID 23714311.

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