Ten-year screening for thrombocytopenia after aortic valve replacement.
OBJECTIVE
Thrombocytopenia is very common after cardiac surgery, but rarely studied systematically. Heparin-induced thrombocytopenia has been studied extensively, but the diagnosis remains clouded by the lack of sensitivity and specificity of laboratory tests. It remains unknown whether a local initiative of screening program has been successful in the management of postoperative thrombocytopenia.


METHODS
We have implemented a screening protocol since 2002. Cardiac surgery patients were postoperatively screened for thrombocytopenia. Thrombocytopenia was stratified by the anti-platelet factor 4/heparin antibody (enzyme-immune assay, Elisa) test. The presence of clinical embolithrombosis was sought in patients with antibodies. Preoperative and operative characteristics and outcomes were obtained from the departmental registry of cardiac surgical procedures.


RESULTS
A total of 16 529 patients were screened for thrombocytopenia from January 2003 to 2012. One thousand two hundred and sixty-one patients undergoing isolated aortic valve replacement (AVR) were included in this study. The overall incidence of thrombocytopenia after AVR was 26.8%. Elisa (+) occurred in 43 of the 1261 patients (3.4%), Elisa (+) plus thrombosis occurred in 14 (1.1%) and in 32.6% of Elisa (+) patients. Age and preoperative lower platelet count were independent predictors of thrombocytopenia. Elisa (+) alone was associated with increased operative mortality, stroke and bleeding. Patients developed thrombocytopenia and Elisa (+) were more likely to receive bioprosthetic valves.


CONCLUSIONS
Thrombocytopenia and Elisa (+) are more common after AVR than after other procedures, and both were associated with increased adverse clinical outcomes. Age and lower preoperative platelet count were associated with postoperative thrombocytopenia and Elisa (+).
Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, DC, USA.
Xiumei
X
Sun
Peter C
PC
Hill
Jennifer
J
Ellis
Paul J
PJ
Corso
Sharon L
SL
Taylor-Panek
Fang
F
Chen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood; D000925:Anticoagulants / Q000276:immunology / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001705:Bioprosthesis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006493:Heparin / Q000276:immunology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000276:immunology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
D000906:Antibodies; D000925:Anticoagulants; D015415:Biomarkers; D010978:Platelet Factor 4; D006493:Heparin
Aortic valvular replacement; Postoperative thrombocytopenia screening protocol; Thrombocytopenia