What is the clinical evidence from this study?

Study design: Cohort. Population: Heparin-induced thrombocytopenia (HIT) (n=207). Intervention: Buffer-positive SRA pattern vs. Buffer-negative SRA pattern. Primary outcome: cumulative incidence of thrombosis (p=0.275).

What does this research mean for the field?

A buffer-positive serotonin release assay pattern in heparin-induced thrombocytopenia is independently associated with prolonged thrombocytopenia and increased 30-day mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare clinical characteristics and outcomes, including thrombosis, platelet recovery, and mortality, between heparin-induced thrombocytopenia patients exhibiting buffer-negative versus buffer-positive serotonin release assay patterns.

September 30, 2026Research and Practice in Thrombosis and HaemostasisOpen Access

A Buffer-Positive Serotonin Release Assay Pattern is Associated with Increased Mortality in Heparin-Induced Thrombocytopenia: A Retrospective Cohort Study

Q: What are the key findings of this study?

A buffer-positive SRA pattern in HIT patients was not associated with increased thrombosis (64.7% vs 50.2%; P=0.275) but was linked to higher 30-day mortality (adjusted HR 2.74; P=0.033).

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Key result

Buffer-positive SRA pattern fails to predict thrombosis in HIT but links to ~174% higher mortality.

P=0.275
n=207

Why the study?

The clinical significance of a buffer-positive serotonin release assay pattern in heparin-induced thrombocytopenia remains uncertain.

Does a buffer-positive SRA pattern predict increased thrombosis or mortality in patients with heparin-induced thrombocytopenia?

Population

207 patients with confirmed heparin-induced thrombocytopenia at the Hospital of the University of Pennsylvania and affiliated hospitals

Comparison

Buffer-negative versus buffer-positive serotonin release assay patterns

Design

Retrospective cohort study

Follow-up

30 days

Authors

TRTarinee RungjirajittranonSiriraj Hospital TWTheodore E. Warkentin ACAdam CukerBrigham and Women's Hospital

Discussion

Member takes

Implication

Buffer-positive SRA in HIT was associated with higher mortality; leaves open whether this pattern warrants targeted interventions pending prospective validation.

Key Points

To compare clinical characteristics and outcomes, including thrombosis, platelet recovery, and mortality, between heparin-induced thrombocytopenia patients exhibiting buffer-negative versus buffer-positive serotonin release assay patterns.
Conducted a retrospective cohort study of 207 consecutive patients with confirmed heparin-induced thrombocytopenia at the Hospital of the University of Pennsylvania and affiliated hospitals.
Diagnosed patients using a positive PF4/heparin enzyme-linked immunoassay and platelet-rich plasma-based serotonin release assay without high-heparin inhibition, classifying them by buffer status and tracking outcomes for 30 days.
Cumulative incidence of thrombosis did not differ significantly between buffer-positive and buffer-negative groups (64.7% vs. 50.2%; P=0.275).
The buffer-positive pattern was independently associated with higher 30-day cumulative mortality (47.4% vs. 17.1%; adjusted HR 2.74; P=0.033) and longer time to platelet recovery (9.0 vs. 5.0 days; P=0.026).
Patients with the buffer-positive pattern demonstrated significantly lower median anti-PF4/heparin optical density values compared to the buffer-negative group (0.8 vs. 2.3; P < 0.001).

Study Design

Type

Cohort (n=207)

Multicenter

Yes

Structured PICO

Does a buffer-positive SRA pattern predict increased thrombosis or mortality in patients with heparin-induced thrombocytopenia?

Population

207 patients with confirmed heparin-induced thrombocytopenia, classified by SRA pattern and followed for 30 days.

Exposure

Buffer-positive SRA pattern

Comparator

Buffer-negative SRA pattern

Outcome

Cumulative incidence of thrombosis at 30 dayshard clinical

Main Result

Absolute Event Rate: 64.7% vs 50.2%

p-value: p=0.275

In patients with heparin-induced thrombocytopenia, a buffer-positive SRA pattern is associated with significantly higher 30-day mortality and delayed platelet recovery, suggesting it may serve as a marker of higher clinical risk.

Limitations

Assay used platelet-rich plasma, requiring confirmation with the classical washed-platelet SRA.
Assay used platelet-rich plasma instead of classical washed-platelet SRA
Findings are hypothesis-generating and require confirmation

Cite This Study

Rungjirajittranon et al. (2026) conducted a cohort in Heparin-induced thrombocytopenia (HIT) (n=207). Buffer-positive SRA pattern vs. Buffer-negative SRA pattern was evaluated on cumulative incidence of thrombosis (p=0.275). A buffer-positive SRA pattern in HIT patients was not associated with increased thrombosis (64.7% vs 50.2%; P=0.275) but was linked to higher 30-day mortality (adjusted HR 2.74; P=0.033).

synapsesocial.com/papers/6abc576efbfca106a1247edc https://doi.org/10.1016/j.rpth.2026.106995

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Implication

Buffer-positive SRA in HIT was associated with higher mortality; leaves open whether this pattern warrants targeted interventions pending prospective validation.

A Buffer-Positive Serotonin Release Assay Pattern is Associated with Increased Mortality in Heparin-Induced Thrombocytopenia: A Retrospective Cohort Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

A Buffer-Positive Serotonin Release Assay Pattern is Associated with Increased Mortality in Heparin-Induced Thrombocytopenia: A Retrospective Cohort Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider