title: Contaminated heparin and outcomes after cardiac surgery: a retrospective propensity-matched cohort study.
abstract: BACKGROUND
  During 2007 and 2008 it is likely that millions of patients in the US received heparin contaminated (CH) with oversulfated chondroitin sulfate, which was associated with anaphylactoid reactions. We tested the hypothesis that CH was associated with serious morbidity, mortality, intensive care unit (ICU) stay and heparin-induced thrombocytopenia following adult cardiac surgery.
  
  
  RESULTS
  We conducted a single center, retrospective, propensity-matched cohort study during the period of CH and the equivalent time frame in the three preceding or the two following years. Perioperative data were obtained from the institutional record of the Society of Thoracic Surgeons National Database, for which the data collection is prospective, standardized and performed by independent investigators. After matching, logistic regression was performed to evaluate the independent effect of CH on the composite adverse outcome (myocardial infarction, stroke, pneumonia, dialysis, cardiac arrest) and on mortality. Cox regression was used to determine the association between CH and ICU length of stay. The 1∶5 matched groups included 220 patients potentially exposed to CH and 918 controls. There were more adverse outcomes in the exposed cohort (20.9% versus 12.0%; difference  =  8.9%; 95% CI 3.6% to 15.1%, P < 0.001) with an odds ratio for CH of 2.0 (95% CI, 1.4 to 3.0, P < 0.001). In the exposed group there was a non-significant increase in mortality (5.9% versus 3.5%, difference = 2.4%; 95% CI, -0.4 to 3.5%, P  =  0.1), the median ICU stay was longer by 14.1 hours (interquartile range -26.6 to 79.8, S = 3299, P = 0.0004) with an estimated hazard ratio for CH of 1.2 (95% CI, 1.0 to 1.4, P = 0.04). There was no difference in nadir platelet counts between cohorts.
  
  
  CONCLUSIONS
  The results from this single center study suggest the possibility that contaminated heparin might have contributed to serious morbidity following cardiac surgery.
authors.affiliation: Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States of America.
authors.forename: Heiko A
authors.initials: HA
authors.lastname: Kaiser
authors.affiliation: Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States of America.
authors.forename: Arbi
authors.initials: A
authors.lastname: Ben Abdallah
authors.affiliation: Department of Mathematics, Washington University in Saint Louis, Saint Louis, Missouri, United States of America.
authors.forename: Nan
authors.initials: N
authors.lastname: Lin
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, Saint Louis, Missouri, United States of America.
authors.forename: Bethany R
authors.initials: BR
authors.lastname: Tellor
authors.affiliation: Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States of America.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Helwani
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, Saint Louis, Missouri, United States of America.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Smith
authors.affiliation: Department of Cardiothoracic Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States of America.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
authors.affiliation: Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, United States of America.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Avidan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002809:Chondroitin Sulfates / Q000008:administration & dosage / Q000009:adverse effects*; D004340:Drug Contamination; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced / Q000401:mortality / Q000473:pathology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000401:mortality / Q000473:pathology; D016017:Odds Ratio; D011014:Pneumonia / Q000139:chemically induced / Q000401:mortality / Q000473:pathology; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis
chemical_list: D006493:Heparin; D002809:Chondroitin Sulfates