title: Incidence and outcomes of heparin-induced thrombocytopenia in patients undergoing cardiac surgery in North America: an analysis of the nationwide inpatient sample.
abstract: OBJECTIVE
  The objective of this study was to quantify the impact of heparin-induced thrombocytopenia (HIT) on outcomes after cardiac surgery.
  
  
  METHODS
  Retrospective analysis of national database.
  
  
  METHODS
  United States hospitals.
  
  
  METHODS
  Patients identified from 186,771 discharge records undergoing cardiac surgery from the Nationwide Inpatient Sample between 2009 and 2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  Heparin-induced thrombocytopenia was diagnosed in 506 (0.3%), and secondary thrombocytopenia was diagnosed in 16,809 (8.7%). Operative mortality was 11.1% in patients with HIT compared to 4.5% for patients without thrombocytopenia (p<0.001) and 4.0% for patients with a diagnosis of secondary thrombocytopenia (p<0.001). After adjusting for baseline patient comorbidity, the strongest independent predictors of HIT in patients undergoing cardiac surgery were female gender (OR 1.4, 95% confidence interval [CI] 1.28-1.48), congestive heart failure (OR 1.8, 95% CI 1.71-1.98), cardiac insufficiency (OR 2.2, 95% CI 1.97-2.39), atrial fibrillation (OR 1.4, 95% CI 1.30-1.51), liver disease (OR 2.2, 95% CI 1.96-2.50), and chronic renal failure (OR 1.4, 95% CI 1.30-1.51). HIT was associated with significantly increased risk of major adverse postoperative outcomes including death (OR 1.5, 95% CI 1.3-1.7), stroke (OR 2.4, 95% CI 1.9-3.1), amputation (OR 7.46, 95% CI 4.0-14.0), and acute renal failure (OR 2.3, 95% CI 2.1-2.5), respiratory failure (OR 1.9, 95% CI 1.8-2.1), and need for tracheostomy (OR 2.7, 95% CI 2.3-3.1).
  
  
  CONCLUSIONS
  Heparin-induced thrombocytopenia is associated with a 50% increase in early mortality, and most patients with this diagnosis experience major postoperative morbidity or functional deficits.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Matthew
authors.initials: M
authors.lastname: Seigerman
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Cavallaro
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, NY.
authors.forename: Insung
authors.initials: I
authors.lastname: Chung
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY. Electronic address: Joanna.chikwe@mountsinai.org.
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: HIT; cardiac surgery; complications; heparin; platelets; thrombocytopenia