Background: Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated complication of heparin exposure, typically occurring 5–14 days after its initiation. It can oftentimes be fatal if not diagnosed promptly. Although platelet transfusion is generally avoided due to thrombotic risk, data on real-world outcomes remain limited. We analyzed the National Inpatient Sample (NIS) to evaluate recent trends in platelet transfusion use in HIT, associated mortality, and healthcare disparities from 2016 to 2020.

Methods: We analyzed the NIS database for hospitalizations with a diagnosis of HIT (ICD-10 code D75.82) and identified those with a secondary diagnosis of deep vein thrombosis (ICD-10 codes I824, I825, and I826) and platelet transfusions (ICD-10 codes 30233N1). Comprehensive logistic and linear regression models were used to identify predictors of in-hospital mortality and length of stay (LOS), respectively. Adjusted odds ratio (aOR) was applied for gender and age. A p-value <0.001 was considered statistically significant, and 95% confidence intervals (CIs) were reported. Patients were divided into two cohorts: Those with HIT who received platelet transfusions and those with HIT without platelet transfusions.

Results: Among 14,513 HIT-related discharges, 13.8% received platelet transfusions. Overall, in-hospital mortality was 11.7% (n= 1,692). Platelet transfusion was independently associated with a higher mortality (aOR 1.52, 95% CI 1.32–1.74, p<0.001) and a longer LOS (mean increase 4.2 days, 95% CI 3.4–4.9, p<0.001). Racial disparities were evident: Black (aOR 1.36, 95% CI 1.18–1.57) and Hispanic patients (aOR 1.44, 95% CI 1.22–1.70) had significantly higher mortality compared to White patients. The “Other” race category—including multiracial individuals and those declining to identify—also demonstrated an increased risk (aOR 1.59, 95% CI 1.20–2.10). No regional differences were observed in the United States. Platelet transfusion was additionally associated with an increased DVT risk (aOR 1.14, 95% CI 1.02–1.29, p=0.028) but not myocardial infarction or stroke.

Conclusion: Our analysis revealed a significant association between platelet transfusion and increased in-hospital mortality and resource utilization among patients diagnosed with HIT. Despite clinical guidelines discouraging transfusion in the absence of bleeding, our findings suggest that this practice persists and may contribute to worse outcomes. Additionally, we observed notable racial disparities, with Black, Hispanic, and patients categorized as Other Race experiencing disproportionately higher adverse outcomes. The data also suggest a potential link between platelet transfusion and the occurrence of deep vein thrombosis (DVT) in this population, warranting further investigation. These findings highlight the need for heightened awareness of transfusion-related risks and underscore the importance of equity-driven care models in managing HIT.

This content is only available as a PDF.
2025
Sign in via your Institution