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Ann Thorac Surg 2007;84:1423-1424
© 2007 The Society of Thoracic Surgeons

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Correspondence

Reply

Deutsches Herzzentrum Berlin, Department of Anesthesia, Augustenburger Platz 1, Berlin, 13353 Germany

(Email: koster@dhzb.de).

The first 20% of the full text of this article appears below.

To the Editor:

Lappa and colleagues [1] commented on what they believe to be potentially misleading aspects of our article reporting on heparin-induced thrombocytopenia (HIT) in patients on ventricular assist device (VAD) support [2]. Some of these comments deserve discussion.

It was pointed out that the laboratory of Lappa and colleagues’ [1] institution observed cross-reactivity of certain proteins (ie, thyroglobulin, peroxidase) with the particle gel assay (PGIA) for anti-heparin/platelet factor 4 antibodies, potentially leading to false positive test results and consequential over-diagnosis of HIT in our study.

This is an interesting observation and we look forward to seeing these data published. It is well known that the current HIT antibody assays are sensitive but have limited specificity, although in this regard the PGIA seems to be superior to the ELISA. Indeed, the stronger the PGIA test result (e.g., result of 3 to 4* [a cutoff we employed]), the more specific the result for HIT [3]. Moreover, in view of these well-recognized limitations (and as outlined in the article), in all of our patients we also performed a "functional" HIT test, the heparin-induced platelet activation assay (HIPAA) (ie, a washed platelet assay for HIT that . . . [Full Text of this Article]

Related Article

HIT in VAD Patients: Considerations

Angela Lappa, Patrizia Picozzi, Emilio D’Avino, Silvia Riondino, Antonio Menichetti, and Francesco Musumeci
Ann. Thorac. Surg. 2007 84: 1422-1423. [Extract] [Full Text] [PDF]

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