Abstract Body (Do not enter title and authors here): Introduction: Heparin is widely used as anticoagulant in hospitals. It is considered a mainstay of therapy in ST-elevation and non-ST elevation myocardial infarction and is included in the ACLS management of these conditions. Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening immune mediated prothrombotic disorder as a consequence of heparin exposure. This is caused by the production of antibody-heparin/PF4 immunocomplex, which causes platelet activation and aggregation. This study aims to determine the effect of HIT on mortality in patients with non-ST elevation myocardial infarction (NSTEMI).
Research Questions/Aims: Given the significant morbidity of myocardial infarction, research is needed to identify factors which increase morbidity and mortality. This study aims to determine the mortality of NSTEMI patients with and without HIT.
Methods: Data was analyzed from available ICD-10 codes from 2016 to 2020. Patients greater than 18 years with ICD-10 codes for NSTEMI with and without HIT were included. The mortality rates were compared between HIT-positive and HIT-negative NSTEMI patients. Patient demographic, clinical, and hospital characteristics were summarized using means and standard deviations for continuous variables, and proportions with 95% confidence intervals for categorical variables. Logistic regression ascertained the odds of binary clinical outcomes relative to patient and hospital characteristics. Multiple logistic regression was used to ascertain the likelihood of the outcome (Odds Ratios (95% CI)) occurring between the characteristics. Analyses were conducted following the implementation of population discharge weights. All p-values were calculated as 2-sided, with a significance level set at p<0.05. Data analysis was performed using STATA 17 (Stata Corporation, College Station, TX).
Result: We found a significant increase in mortality in NSTEMI patients with HIT vs no HIT for years 2016-2020 (odds ratio [OR] = 2.55, 95% confidence interval [CI] = (2.19-2.98), p < 0.05). In addition, cardiogenic shock was associated in NSTEMI patients with HIT vs no hit (OR = 8.66, CI = (8.43-8.90), P < 0.001)
Conclusion: This finding suggests that HIT is associated with increased mortality among NSTEMI patients. In the year 2020, COVID-19 infections may have exacerbated the mortality difference observed in years 2016-2019.