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| Prevalence and Outcomes of Heparin-Induced Thrombocytopenia in Inflammatory Bowel Disease: A Decade Study Ayobami Olafimihan1, Ekrem Turk1, Praise fawehinmi2, Gbolahan Olatunji3, Emmanuel Kokori3, Aderinto Nicholas 4, Alejandro Vallejo1, Nkechi Akata5, Shaka Hafeez1. 1John H.Stroger Jr Hospital, Chicago, IL, USA.2Southern Illinois University Edwardsville, Edwardsville, IL, USA.3University of Ilorin, Ilorin, Nigeria.4Ladoke Akintola University of Technology, Ogbomosho, Nigeria.5Meharry Medical College, Nashville, TN, USA |
Abstract
Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disease linked with increased venous thromboembolism risk. Hence, guidelines recommend the use of pharmacologic thromboprophylaxis in admitted IBD patients from any etiology. Consequently, frequent hospitalizations in IBD patients are associated with heightened exposure to heparin and an increased susceptibility to heparin-induced thrombocytopenia (HIT). Objective: Our goal is to assess the prevalence and outcomes of heparin-induced thrombocytopenia in IBD hospitalizations in the United States. Methodology: This is a retrospective study using the Nationwide Inpatient Sample (NIS) database (2010-2019). Using ICD-9 and ICD-10 codes, we identified hospitalized patients with IBD and stratified them based on having a secondary diagnosis of HIT. The groups were compared for socio-demographic differences. Primary outcomes were inpatient mortality, length of stay > 5 days (LOS), and total hospital charges (THC). Secondary outcomes included odds of acute venous thromboembolism (VTE), acute pulmonary embolism (PE), ischemic stroke and myocardial infarctions (MI). Statistical analyses were performed using t-test, univariate and multivariate logistic regression. Results: Out of 3,093,631 admitted IBD patients, the prevalence of HIT was 0.07% (2,218). Among IBD patients with HIT, 60.5% had crohn’s disease and 39.5% had ulcerative colitis. Majority of IBD patients with HIT were older (58.8 vs 53.1 years), covered by Medicare (56.5 vs 42.4%), and admitted to teaching hospitals (73.1 vs 63.7%) compared to those without HIT (P<0.001). On multivariate adjusted analysis, HIT was associated with almost five-fold higher mortality odds among hospitalized IBD patients (adjusted odds ratio (AOR): 4.6, 95% confidence interval (CI): 3.19-6.53). Those with HIT were five times more likely to have longer hospital stays (AOR: 5.3; 95% CI: 4.19-6.60) and had higher THC (β: $108,007; 95% CI: $87,500-$128,515) compared to those without HIT. On subgroup analysis, UC patients with HIT had six-time higher odds of mortality (AOR:6.25; 95% CI: 3.84-10.18), while CD patients with HIT had three-time greater odds of mortality (AOR: 3.13; 95% CI: 1.80-5.47) compared to those without HIT respectively. Additionally, HIT was associated with a higher odds of acute VTE (AOR: 10.1; 95% CI: 7.83 – 13.03), acute PE (AOR: 8.8; 95% CI: 5.96-12.88), acute MI (AOR:3.8; 95% CI:2.32-6.30), ischemic stroke (AOR: 5.8; 95% CI: 2.96 – 11.29), intracranial hemorrhage (AOR: 8.6; 95% CI: 4.05-18.25), GI bleeding (AOR: 1.7; 95% CI: 1.20-2.38), RBC transfusion (AOR: 3.7; 95% CI: 2.96-4.56), and platelet transfusion (AOR: 8.2; 95% CI: 5.50-12.25) in admitted IBD patients. Conclusion: The occurrence of heparin-induced thrombocytopenia (HIT) in hospitalized individuals with inflammatory bowel disease (IBD) is infrequent. Nevertheless, the presence of HIT in this subgroup is linked to significantly increased odds of inpatient mortality, extended hospitalization, and higher healthcare expenses. It is crucial for physicians to maintain a heightened level of suspicion to facilitate timely diagnosis and intervention, thereby mitigating adverse outcomes.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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