Heparin-induced thrombocytopenia following cardiac surgery is associated with poor outcome.
OBJECTIVE
The outcome of cardiac surgical patients with clinically diagnosed heparin-induced thrombocytopenia (HIT) was studied.


METHODS
Retrospective, observational study.


METHODS
University hospital.


METHODS
All cardiac surgical patients with diagnosed HIT after cardiac surgery between January 2002 and December 2004, and concurrently, consecutive patients without HIT.


METHODS
None Measurements and Main Results: 3465 patients were treated postoperatively in the cardiac surgical intensive care unit during the study period. Clinical suspicion of HIT arose when platelet count markedly fell several days after surgery and HIT was proven by a positive enzyme immunoassay in 20 patients. Thrombocytopenia (35.5 [22] x 10(9)/L, median [interquartile range]) developed within 7 (6) days. HIT patients received significantly more platelet transfusions perioperatively than controls (p < 0.001). Thromboembolic complications occurred in 70% of HIT patients, but in none of non-HIT patients (14/20 v 0/20, p = 0.001). Intensive care unit stay was longer in HIT patients than in controls (16.5 [11.0] v 1.0 [3.0] days, p < 0.001). Nine HIT patients died (45%), while all control patients survived. Mortality was related to thrombotic complications in seven HIT patients (35%).


CONCLUSIONS
The incidence of HIT in association with low-molecular-weight heparin use after cardiac surgery was low. HIT was associated with perioperative platelet transfusions and carried a remarkably high risk of thromboembolic complications and death. In order to reduce morbidity and mortality, early recognition of heparin-associated antiplatelet antibodies and alternative anticoagulation strategies need to be implemented.
Kuitunen
Anne
A
Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. anne.kuitunen@hus.fi
Suojaranta-Ylinen
Raili
R
Raivio
Peter
P
Kukkonen
Sinikka
S
Lassila
Riitta
R
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality
D000925:Anticoagulants; D015415:Biomarkers; D006493:Heparin