Recognition and management of heparin-induced thrombocytopenia in pediatric cardiopulmonary bypass patients.
Repeated exposure to unfractionated heparin is the rule in many congenital heart disease patients. Heparin-induced thrombocytopenia occurs in 1% to 3% of adult cardiac surgeries, and carries high thrombotic morbidity (38% to 81%) and mortality (approximately 28%). Although heparin-induced thrombocytopenia appears to be infrequent in pediatric patients, particularly neonates, our evolving experience suggests postcardiopulmonary bypass congenital heart disease patients may be at increased risk. Diagnostic and therapeutic challenges include frequency of thrombocytopenia after cardiopulmonary bypass, imperfect laboratory testing, lack of established dosing of alternative anticoagulants (such as argatroban and lepirudin), and increased anticoagulant-related bleeding in young children.
Boshkov
Lynn K
LK
Department of Pathology and Medicine, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon 97231, USA. boshkovl@ohsu.edu
Kirby
Aileen
A
Shen
Irving
I
Ungerleider
Ross M
RM
D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects*; D001120:Arginine / Q000031:analogs & derivatives; D001323:Autoantibodies / Q000096:biosynthesis / Q000276:immunology; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D017809:Fatal Outcome; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000097:blood / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015337:Multicenter Studies as Topic; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D010978:Platelet Factor 4 / Q000737:chemistry / Q000276:immunology; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome
D000925:Anticoagulants; D001323:Autoantibodies; D006629:Hirudins; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D010978:Platelet Factor 4; D006493:Heparin; D001120:Arginine; C031942:argatroban; C083544:lepirudin