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Indeterminate serotonin release assays are associated with a high mortality rate
Shawn Jindal1, Christopher Leyton1, Fred Cohen1
1Department of Medicine Montefiore Medical Center and the Albert Einstein College of Medicine Bronx New York USA.
Research and Practice in Thrombosis and Haemostasis
|June 23, 2022
Summary
Indeterminate serotonin release assay (SRA) results in suspected heparin-induced thrombocytopenia (HIT) patients are linked to higher mortality. This suggests in vivo platelet activation, not heparin-related, may be occurring.
Area of Science:
- Hematology
- Immunology
- Clinical Medicine
Background:
- The serotonin release assay (SRA) is the gold standard for diagnosing heparin-induced thrombocytopenia (HIT).
- However, up to 10% of SRA tests yield indeterminate results, complicating diagnosis and patient management.
Purpose of the Study:
- To investigate the clinical course and outcomes of patients with indeterminate SRA results.
- To understand the implications of indeterminate SRA findings in the context of suspected HIT.
Main Methods:
- A cohort analysis of 2056 patients who underwent SRA testing was conducted.
- Clinical data, including platelet counts, intensive care unit (ICU) treatment, and mortality, were analyzed.
Main Results:
- Of 2056 patients, 152 (7.4%) had indeterminate SRA results.
- Patients with indeterminate SRA showed higher rates of severe thrombocytopenia and ICU admission compared to those with negative SRA.
- Inpatient mortality was significantly higher in patients with indeterminate SRA (49.3%) compared to positive (21.1%) or negative (27.2%) SRA results.
Conclusions:
- Indeterminate SRA results may indicate in vivo platelet activation unrelated to heparin.
- These findings are associated with significantly increased inpatient mortality.
- Further research is warranted to elucidate the mechanisms and clinical significance of indeterminate SRA results.
