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The benefits and risks of such treatments have not been fully assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data for 442 patients having a positive heparin\u2010platelet factor 4 antibody test and recent heparin exposure. The primary outcome was a composite endpoint (death, limb amputation\/gangrene, or new thrombosis). Secondary outcomes included bleeding and the effect of anticoagulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010one patients (16%) had HIT with thrombosis (HIT\u2010T); 284 (64%) had HIT without thrombosis (isolated HIT); 87 (20%) did not have HIT. An intermediate or high \u201c4T\u201d score was found in 85%, 58%, and 8% of the three respective groups. Non\u2010heparin anticoagulation was begun in 80%, 56%, and 45%. The composite endpoint occurred in 48%, 36%, and 17% (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.01) of which 61%, 38%, and 40% were receiving non\u2010heparin anticoagulation. Compared with the no HIT group, the composite endpoint was significantly more likely in HIT\u2010T [HR 2.48 (1.35\u20104.55),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.003)] and marginally more likely in isolated HIT [HR 1.66 (0.96\u20102.85),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.071]. Importantly, risk increased (HR 1.77,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.02) after platelet transfusion. Major bleeding occurred in 48%, 36%, and 16% of the three groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.005). Non\u2010heparin anticoagulation was not associated with a reduction in composite endpoint events in either HIT group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>HIT patients have high risks of death, limb amputation\/gangrene, thrombosis, and bleeding. Non\u2010heparin anticoagulant treatment may not benefit all patients and should be considered only after careful assessment of the relative risks of thrombosis and bleeding in individual patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajh.24759","type":"journal-article","created":{"date-parts":[[2017,4,7]],"date-time":"2017-04-07T19:16:18Z","timestamp":1491592578000},"page":"730-738","source":"Crossref","is-referenced-by-count":67,"title":["Clinical outcomes in a cohort of patients with heparin\u2010induced thrombocytopenia"],"prefix":"10.1002","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7855-2409","authenticated-orcid":false,"given":"David J.","family":"Kuter","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara A.","family":"Konkle","sequence":"additional","affiliation":[{"name":"Puget Sound Blood Center and University of 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