Presentation, management and outcome of heparin-induced thrombocytopenia after valvular heart surgery.
OBJECTIVE
The use of heparin exposes patients to heparin-induced thrombocytopenia, which is a challenging issue for both diagnosis and patient management. We sought to describe the clinical presentation, management and outcome of a series of patients diagnosed with heparin-induced thrombocytopenia after heart valve surgery.


METHODS
All consecutive patients diagnosed with heparin-induced thrombocytopenia during the postoperative period of heart valve surgery over a 6-year period were prospectively enrolled in a single-centre registry. Clinical and biological data were collected. In-hospital and mid-term outcomes were assessed. Information regarding the occurrence of all medical events including death, recurrence of thromboembolic events and/or thrombocytopenia was collected.


RESULTS
We identified 93 patients (incidence proportion = 2.8%). Most patients (82%) were asymptomatic with isolated thrombocytopenia at the time of diagnosis. The other main circumstance of diagnosis was the occurrence of thromboembolic events in 17 patients (6 strokes, 10 prosthetic valve thrombosis and 1 peripheral embolic event). The in-hospital mortality rate was 1%. No thrombolysis, interventional procedure or redo surgery was performed. Danaparoid sodium was used as heparin replacement therapy in most cases (96%) and leading to complete and uneventful thrombus resolution in all cases with only one possibly related major bleeding complication. During a mean follow-up of 36 ± 20 months, no patient presented recurrence of any heparin-induced thrombocytopenia-related complication.


CONCLUSIONS
In this contemporary series of patients, heparin-induced thrombocytopenia incidence was low and isolated thrombocytopenia was the most frequent presentation. Conservative management with early diagnosis and substitutive anticoagulation therapy introduction was associated with a low rate of clinical events and a remarkably good outcome with a low mortality rate.
Department of Cardiology, Bichat Hospital, Paris, France.|INSERM U1148, Bichat Hospital, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.
Dimitri
D
Arangalage
Department of Cardiac Surgery, Bichat Hospital, Paris, France.
Laurent
L
Lepage
INSERM U1148, Bichat Hospital, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.|Department of Hematology, Bichat Hospital, Paris, France.
Dorothée
D
Faille
Department of Cardiac Surgery, Bichat Hospital, Paris, France.
Claire
C
Cimadevilla
Department of Anesthesiology, Bichat Hospital, Paris, France.
Marie-Pierre
MP
Dilly
Department of Pharmacy, Bichat Hospital, Paris, France.
Emmanuelle
E
Papy
Department of Biological Hematology, European Hospital Georges Pompidou, AP-HP, Paris, France.
Martine
M
Alhenc-Gelas
Department of Cardiac Surgery, Bichat Hospital, Paris, France.
Walid
W
Ghodbane
INSERM U1148, Bichat Hospital, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.|Department of Cardiac Surgery, Bichat Hospital, Paris, France.
Patrick
P
Nataf
Department of Cardiology, Bichat Hospital, Paris, France.|INSERM U1148, Bichat Hospital, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.
Bernard
B
Iung
Department of Cardiology, Bichat Hospital, Paris, France.|INSERM U1148, Bichat Hospital, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.
Philippe Gabriel
PG
Steg
Department of Cardiology, Bichat Hospital, Paris, France.|INSERM U1148, Bichat Hospital, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.
Alec
A
Vahanian
INSERM U1148, Bichat Hospital, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.|Department of Hematology, Bichat Hospital, Paris, France.
Nadine
N
Ajzenberg
Department of Cardiology, Bichat Hospital, Paris, France david.messika-zeitoun@bch.aphp.fr.|INSERM U1148, Bichat Hospital, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.
David
D
Messika-Zeitoun
D000925:Anticoagulants / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004452:Echocardiography; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011184:Postoperative Period; D011446:Prospective Studies; D012042:Registries; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D013923:Thromboembolism / Q000209:etiology
D000925:Anticoagulants; D006493:Heparin
Cardiac surgery; Heparin; Heparin-induced thrombocytopenia; Thrombocytopenia