title: Impact of heparin-induced thrombocytopenia on outcome in patients with ventricular assist device support: single-institution experience in 358 consecutive patients.
abstract: BACKGROUND
  Cardiac surgical patients are at an approximate 1% to 2% risk of experiencing heparin-induced thrombocytopenia (HIT), a severe immune-mediated disease that is associated with thromboembolic events. We assessed the occurrence of this disease and its influence on clinical outcome in patients after implantation of a ventricular assist device (VAD).
  
  
  METHODS
  This retrospective analysis assessed data from our adult patient VAD program between the years 2000 and 2005. Patients were divided into three groups: those without confirmed HIT ((non)HIT), those in whom the diagnosis of HIT was made before VAD implantation (HIT(pre)), and those who experienced HIT after VAD implantation (HIT(post)). End points assessed were procedural success, as defined by discharge from hospital or transplantation or recovery of the failing heart, as opposed to death before procedural success was achieved.
  
  
  RESULTS
  The data of 358 consecutive patients were analyzed. There were 330 (non)HIT patients (91.6%), 15 HIT(pre) patients (4.5%), and 13 HIT(post) patients (3.9%). Procedural success was observed in 50% of (non)HIT patients, 67% of HIT(pre) patients, and 31% of HIT(post) patients.
  
  
  CONCLUSIONS
  Heparin-induced thrombocytopenia is a frequent complication in VAD patients and is associated with detrimental outcome when occurring after implantation. Preoperative diagnosis of HIT and the implementation of alternative anticoagulation procedures appears to be associated with better results. Early detection of HIT antibodies before or shortly after VAD implantation and immediate implementation of an alternative anticoagulation regimen may be a strategy to improve outcome.
authors.affiliation: Department of Anesthesia, Deutsches Herzzentrum Berlin, Germany. koster@dhzb.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.forename: Sabine
authors.initials: S
authors.lastname: Huebler
authors.forename: Evgenij
authors.initials: E
authors.lastname: Potapov
authors.forename: Oliver
authors.initials: O
authors.lastname: Meyer
authors.forename: Michael
authors.initials: M
authors.lastname: Jurmann
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Weng
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.forename: Thorsten
authors.initials: T
authors.lastname: Drews
authors.forename: Hermann
authors.initials: H
authors.lastname: Kuppe
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000925:Anticoagulants; D006493:Heparin