Heparin-induced thrombocytopenia type II after cardiac surgery: predictors and outcome.
BACKGROUND
Heparin-induced thrombocytopenia (HIT) is a serious complication after cardiac surgery. The aim of the present study was to identify pre- and intraoperative predictors for the postoperative occurrence of HIT. The study additionally focused on the impact of HIT on postoperative outcome.


METHODS
Retrospective analysis was performed for 5073 patients who had required extracorporeal circulation during cardiac surgery. Patients were divided into 3 groups: 1) patients who had postoperative HIT (HIT+); 2) patients with postoperative thrombocytopenia but without HIT (HIT-); and 3) patients with normal platelet count (C). The groups were statistically compared with regard to pre-, intra- and postoperative parameters.


RESULTS
Statistically significant predictors were renal insufficiency, intravenous application of heparin for more than 3 days, previous percutaneous coronary intervention within the last 4 weeks, urgency/emergency operation, combined surgery, prolonged extracorporeal circulation or cross-clamping time, and low cardiac output syndrome. Postoperative HIT was associated with an enhanced risk of renal failure, infectious and thromboembolic complications and in-hospital mortality.


CONCLUSIONS
Postoperative HIT increases morbidity and mortality. The predictors presented in this study can be used to identify patients at risk of developing HIT.
Department of Cardiovascular Surgery, University Hospital, Düsseldorf, Germany.
A
A
Assmann
U
U
Boeken
P
P
Feindt
P
P
Schurr
P
P
Akhyari
A
A
Lichtenberg
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D005858:Germany; D006493:Heparin / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010976:Platelet Count; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin