Positive Heparin/PF4 Antibodies and High Mortality Rate: a Retrospective Case-Series Analysis

Ezelsoy, Mehmet; Saraçoğlu, Kemal Tolga; Oral, Kerem; Saraçoğlu, Ayten; Akpınar, Belhhan

doi:10.21470/1678-9741-2019-0360

Cited by 2 publications

(4 citation statements)

References 16 publications

(6 reference statements)

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“…Thrombocytopenia occupies an important place among the variables that determine the high-risk groups during this follow-up period. 4,6,10…”

Section: Discussionmentioning

confidence: 99%

“…Thrombocytopenia occupies an important place among the variables that determine the high-risk groups during this follow-up period. 4,6,10 This study focused on the patients who had thrombocytopenia after open-heart surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The degree of thrombocytopenia was classified into two groups: mild (platelet count 100 × 10 3 to 150 × 10 3 /μL) and moderate-severe (moderate 50 × 10 3 to 99 × 10 3 /μL and severe <50 × 10 3 /μL). 10 The inclusion and exclusion criteria are listed in Table 1. Three hundred twenty patients without thrombocytopenia and 21 patients who diagnosed as having a high probability of (HIT) according to the 4T clinical scoring system during hospital follow-up were excluded from the study (Table 2).…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, HIT is diagnosed with clinical suspicion and a clinical score. [9][10][11] To assess the clinical probability, 4T probability scoring must be performed (Table 1). 11 Although the incidence of HIT is low in patients undergoing open-heart surgery, an increased early mortality rate has been observed in patients with positive heparin/PF4 antibodies.…”

Section: Introductionmentioning

confidence: 99%

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Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Keleş¹,

Bilen²,

Aygün³

et al. 2022

Perfusion

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Background Thrombocytopenia (platelet count below 150 x 103/μL) is a common finding after open-heart surgery and can lead to various complications, including patient death. This study aimed to determine the extent of non–heparin-induced thrombocytopenia in open-heart surgery and to highlight the associated factors. Materials and Methods In this cohort study, 842 patients who underwent valve and/or coronary bypass surgery over a 5-year period were retrospectively analyzed. After open-heart surgery, patients whose platelet count was less than 150 x 103/μL on a complete blood count 12 and 24 h after surgery were classified as thrombocytopenic. Three hundred twenty patients without thrombocytopenia and 21 patients with a high probability of heparin-induced thrombocytopenia were excluded from the study. Logistic regression analysis was used to assess the association of independent variables in moderate-severe thrombocytopenia: Age groups, sex, underlying disease, symptoms, type of surgery, pump time, pulsatile or non-pulsatile duration, degree of hypothermia, hemodilution, oxygenator type, use of an intra-aortic balloon, and erythrocyte transfusion counts were included in the analysis. Results A total of 501 patients were diagnosed as having non–heparin-induced thrombocytopenia, and 64.3% were male. Three hundred seventy-seven (75.2%) patients had mild thrombocytopenia and 124 (24.7%) had moderate-severe thrombocytopenia. The postoperative platelet count was significantly lower than the preoperative platelet count (213 x 103 vs.117 x 103/μL; p < 0.001). Moderate-severe thrombocytopenia was associated with age ≥80 years odds (OR = 9.026, 95% CI: [1.757–46.363]; p = 0.008), isolated valve surgery (OR = 3.090, 95% CI: [1.867–5.114]; p < 0.001), and valve surgery with coronary bypass (OR = 4.938, 95% CI: [1.638–14.889]; p = 0.005) compared to isolated coronary bypass, type of oxygenator (Nipro vital compared with Affinity OR = 11.097, 95% CI: [1.923–64.023]; p = 0.007), erythrocyte transfusion count (OR = 1.219, 95%CI: [1.046–1.420]; p = 0.011). Conclusion Age 80 years or older, surgical procedures including heart-valve surgery, and the number of red blood cell transfusions are associated with the risk of moderate-to-severe thrombocytopenia. This study provides a guide in terms of risk factors that may lead to moderate-to-severe thrombocytopenia after open-heart surgery. However, future multicentre prospective randomized studies may provide more detailed information on this subject.

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“…Thrombocytopenia occupies an important place among the variables that determine the high-risk groups during this follow-up period. 4,6,10…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Keleş¹,

Bilen²,

Aygün³

et al. 2022

Perfusion

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Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review

Sousa

Romoli

Kammen³

et al. 2022

Stroke

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Background: Cerebral venous thrombosis (CVT) has recently been reported as a common thrombotic manifestation in association with vaccine-induced thrombotic thrombocytopenia, a syndrome that mimics heparin-induced thrombocytopenia (HIT) and occurs after vaccination with adenovirus-based SARS-CoV-2 vaccines. We aimed to systematically review the incidence, clinical features, and prognosis of CVT occurring in patients with HIT. Methods: The study protocol was registered with PROSPERO (CRD42021249652). MEDLINE, EMBASE and Cochrane CENTRAL were searched up to June 1, 2021 for HIT case series including >20 patients, or any report of HIT-related CVT. Demographic, neuroradiological, clinical, and mortality data were retrieved. Meta-analysis of proportions with random-effect modeling was used to derive rate of CVT in HIT and in-hospital mortality. Pooled estimates were compared with those for CVT without HIT and HIT without CVT, to determine differences in mortality. Results: From 19073 results, we selected 23 case series of HIT (n=1220) and 27 cases of HIT-related CVT (n=27, 71% female). CVT developed in 1.6% of 1220 patients with HIT (95% CI,1.0%–2.5%, I 2 =0%). Hemorrhagic brain lesions occurred in 81.8% of cases of HIT-related CVT and other concomitant thrombosis affecting other vascular territory was reported in 47.8% of cases. In-hospital mortality was 33.3%. HIT-related CVT carried a 29% absolute increase in mortality rate compared with historical CVT controls (33.3% versus 4.3%, P <0.001) and a 17.4% excess mortality compared with HIT without CVT (33.3% versus 15.9%, P =0.046). Conclusions: CVT is a rare thrombotic manifestation in patients with HIT. HIT-related CVT has higher rates of intracerebral hemorrhage and a higher mortality risk, when compared with CVT in historical controls. The recently reported high frequency of CVT in patients with vaccine-induced thrombotic thrombocytopenia was not observed in HIT, suggesting that additional pathophysiological mechanisms besides anti-platelet factor-4 antibodies might be involved in vaccine-induced thrombotic thrombocytopenia-related CVT.

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Positive Heparin/PF4 Antibodies and High Mortality Rate: a Retrospective Case-Series Analysis

Cited by 2 publications

References 16 publications

Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Cerebral Venous Thrombosis in Patients With Heparin-Induced Thrombocytopenia a Systematic Review

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