Incidence of heparin-induced thrombocytopenia and therapeutic strategies in pediatric cardiac surgery.
BACKGROUND
We identified the incidence of heparin-induced thrombocytopenia and the antiheparin-platelet factor 4 (PF4) antibody in pediatric patients undergoing cardiac surgery and documented the differences in the anticoagulation management for the extracorporeal circulation.


METHODS
Between January 2001 and September 2003, 559 cardiac procedures with extracorporeal circulation in 415 patients with congenital heart defects were performed in our institution. Because the development of heparin-induced thrombocytopenia requires previous exposition to heparin, only the 144 patients undergoing a scheduled second procedure on extracorporeal circulation were screened preoperatively. Of these 144 patients, 41 underwent also a third procedure and were screened before each procedure for presence of antiheparin-PF4 antibodies and for clinical signs of heparin-induced thrombocytopenia.


RESULTS
The incidence of antiheparin-PF4 antibodies during the study period was 1.4% (2 of 144 patients). Patients with clinically significant heparin-induced thrombocytopenia could not be identified. Outside the study protocol, 2 more patients with antiheparin-PF4 antibodies were found. In these 4 patients, surgery was performed using lepirudin (Schering, Berlin, Germany) instead of the usual heparin management for extracorporeal circulation. Three of these 4 patients had an uneventful procedure and postoperative course. In 1 patient after total cavopulmonary connection, a reoperation was necessary on the seventh postoperative day owing to partial thrombosis of the lateral tunnel.


CONCLUSIONS
The incidence of heparin-induced thrombocytopenia and of antiheparin-PF4 antibodies in patients undergoing repeated cardiac surgery is low. In antiheparin-PF4 antibody positive patients, the complete avoidance of heparin can be achieved and may account for an uneventful perioperative course.
Böning
Andreas
A
Department of Cardiovascular Surgery, University Hospital Kiel, Hamburg, Germany. aboening@kielheart.uni-kiel.de
Morschheuser
Torsten
T
Bläse
Udo
U
Scheewe
Jens
J
von der Brelie
Michael
M
Grabitz
Ralf
R
Cremer
Jochen T
JT
D000925:Anticoagulants / Q000009:adverse effects* / Q000276:immunology; D006348:Cardiac Surgical Procedures; D000075202:Contraindications; D005112:Extracorporeal Circulation; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery; D006493:Heparin / Q000009:adverse effects* / Q000737:chemistry / Q000276:immunology; D006629:Hirudins; D006801:Humans; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000150:complications; D010978:Platelet Factor 4 / Q000737:chemistry / Q000276:immunology*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology; D011300:Preoperative Care; D011994:Recombinant Proteins / Q000627:therapeutic use; D012086:Reoperation; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000453:epidemiology
D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins; D010978:Platelet Factor 4; D006493:Heparin; C083544:lepirudin