Heparin-induced thrombocytopenia in open heart surgical patients: sequelae of late recognition.
Most patients undergoing open heart operations have had exposure to heparin for diagnostic and/or therapeutic procedures. Heparin antibody formation and heparin-induced thrombocytopenia with repeat heparin administration can cause high morbidity and mortality from thrombotic complications, especially when delay in diagnosis occurs. From 1981 to 1991, heparin-induced thrombocytopenia was diagnosed in 82 of 4,261 open heart surgical patients (1.9%). Platelet counts less than 100 x 10(9)/L (100,000/microL) or new or recurring thrombotic events prompted suspicion of heparin-induced thrombocytopenia. Heparin-dependent antibody was diagnosed preoperatively in 12 patients (group I) and postoperatively in 70 patients (group II). Heparin was not given postoperatively in group I patients, and complications in this group were limited to bleeding in 3 patients. There were no thromboembolic events and all patients survived. Group II patients had late recognition of heparin-dependent antibody postoperatively, and heparin exposure was continued for varying periods postoperatively. Thirty-seven group II patients (53%) had bleeding complications and 31 (44%) had thromboembolic complications. These complications led to death in 23 group II patients (33%). Heparin-dependent antibody may occur in patients having open heart operations and is a major cause of morbidity and mortality if not diagnosed early with cessation of heparin therapy.
Walls
J T
JT
Division of Cardiothoracic, University of Missouri, Columbia 65212.
Curtis
J J
JJ
Silver
D
D
Boley
T M
TM
Schmaltz
R A
RA
Nawarawong
W
W
D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D017707:Erythrocyte Transfusion; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000628:therapy; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008477:Mediastinal Diseases / Q000139:chemically induced / Q000628:therapy; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010976:Platelet Count / Q000187:drug effects; D011655:Pulmonary Embolism / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D013921:Thrombocytopenia / Q000139:chemically induced*
D000906:Antibodies; D006493:Heparin