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Systematic review on heparin-induced thrombocytopenia in children: a call to action
M L Avila1, V Shah, L R Brandão
1Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
The incidence of Heparin-induced thrombocytopenia (HIT) in children may be overestimated, potentially leading to the misuse of new alternative anticoagulant drugs (NAADs). Further research is needed for accurate diagnosis and management.
Area of Science:
- Pediatric Hematology
- Pharmacology
- Clinical Medicine
Background:
- Heparin-induced thrombocytopenia (HIT) is increasingly reported in pediatric patients.
- This trend has led to the use of new alternative anticoagulant drugs (NAADs) in children.
- Accurate incidence and clinical presentation data for pediatric HIT are crucial.
Purpose of the Study:
- To systematically review the literature on the incidence and prevalence of seroconversion and HIT in children.
- To examine the clinical and laboratory findings associated with pediatric HIT.
- To assess the management strategies employed for HIT in pediatric populations.
Main Methods:
- Comprehensive literature search of MEDLINE and EMBASE databases for pediatric HIT cases.
- Inclusion of studies reporting seroconversion and HIT incidence in neonates and non-neonates.
- Methodological quality assessment using the Loney scale for included studies.
Main Results:
- Neonatal seroconversion incidence ranged from 0% to 1.7%, with no neonatal HIT cases identified.
- Non-neonatal seroconversion incidence varied widely (1.3-52%), and HIT incidence post-cardiopulmonary bypass was 0.33%.
- Over half of reported pediatric HIT cases lacked key diagnostic features, yet 80% received NAADs.
Conclusions:
- The incidence of pediatric HIT appears overestimated, potentially causing inappropriate NAAD use.
- Current literature inadequately describes clinical and laboratory features of pediatric HIT.
- Improved case reporting, laboratory investigation, and study design are essential for clarifying pediatric HIT.
Background:
Heparin-induced thrombocytopenia (HIT) has increasingly been reported in children as an indication for use of new alternative anticoagulant drugs (NAADs).
Objectives:
To systematically review the literature regarding: (i) the incidence and prevalence of seroconversion and HIT and (ii) the clinical/laboratory findings and management of HIT in children.
Design/Methods:
MEDLINE and EMBASE databases were searched for studies that reported pediatric cases of HIT. Methodological reliability assessment of studies was performed with the Loney scale.
Results:
The incidence of seroconversion in neonates ranged between 0% and 1.7%. There were no cases of neonatal HIT in the included cohorts. The incidence range of seroconversion in the non-neonatal population was 1.3-52%. The incidence of HIT in non-neonates after cardiopulmonary bypass was 0.33% (95%CI, < 0.01-2.04). Whereas more than half of pediatric cases labeled as HIT (30/52) did not include pivotal features of this syndrome, 80% of them received NAADs.
Conclusion:
The incidence of HIT is likely to have been overestimated in children, leading to potential misuse of NAADs in many cases. Clinical findings and laboratory assessment of pediatric cases are poorly described in the literature at present. Thorough laboratory investigation, proper reporting of cases and adequate design of studies are mandatory to elucidate the clinical/laboratory picture of pediatric HIT.
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