Heparin-Induced Thrombocytopenia and Cardiac Surgery

Solanki, Jigna; Shenoy, Sundeep; Downs, Emily A.; Palkimas, Surabhi; Goldman, Svetlana; Sharma, Aditya

doi:10.1053/j.semtcvs.2018.10.011

Cited by 19 publications

(18 citation statements)

References 41 publications

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“…HIT has been estimated to occur in 0.1–5% of patients receiving therapeutic doses of heparin. 1–3 Its incidence has been based on the results of modest sample sizes until recently when Dhakal et al reported the results of a large study through the Nationwide Inpatient Sample (NIS), with the caveat that this population-based study relied on coded cases of HIT in an all-payer inpatient United States healthcare database, and therefore may not fully represent the true incidence of HIT. 4 HIT was diagnosed in 0.065% of inpatients, or 1/1500 hospital admissions.…”

Section: Incidence Of Heparin-induced Thrombocytopenia (Hit) In Genermentioning

confidence: 99%

“…In the NIS study, 0.63% of CPB patients developed HIT and represented the highest risk group; however, previous studies have shown higher rates with estimates ranging from 1% to 3%. 6–8 Given that the development of HIT is associated with a 50% increase in early mortality, 2 this finding is of particular importance; however, prevention of HIT proves difficult.…”

Section: Incidence Of Heparin-induced Thrombocytopenia (Hit) In Genermentioning

confidence: 99%

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Heparin-induced thrombocytopenia (HIT): Review of incidence, diagnosis, and management

2020

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Heparin-induced thrombocytopenia (HIT) is a life and limb-threatening complication of heparin exposure. Here, we review the pathogenesis, incidence, diagnosis, and management of HIT. The first step in thwarting devastating complications from this entity is to maintain a high index of clinical suspicion, followed by an accurate clinical scoring assessment using the 4Ts. Next, appropriate stepwise laboratory testing must be undertaken in order to rule out HIT or establish the diagnosis. In the interim, all heparin must be stopped immediately, and the patient administered alternative anticoagulation. Here we review alternative anticoagulation choice, therapy alternatives in the difficult-to-manage patient with HIT, and the problem of overdiagnosis.

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Section: Incidence Of Heparin-induced Thrombocytopenia (Hit) In Genermentioning

confidence: 99%

Section: Incidence Of Heparin-induced Thrombocytopenia (Hit) In Genermentioning

confidence: 99%

Heparin-induced thrombocytopenia (HIT): Review of incidence, diagnosis, and management

2020

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“…Studies have shown that a biphasic pattern—an initial rise and then dramatic fall in platelet counts—is strongly correlated to HIT when observed in patients who required <2 hours of CPB and who are 5 days postoperative. 10 , 18 Upon review of platelet levels trends, we observed that the patient exhibited a biphasic pattern ( Figure 3 ), suggesting possible signs of HIT pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Patients undergoing cardiac surgery have incidence rates of HIT as high as 3%, a sharp contrast to the reported 0.1% to 0.3% rate in the general patient population. 8 - 10 Early recognition and treatment are further obscured by the fact that thrombocytopenia routinely occurs after cardiac surgery. The severity of HIT II in patients undergoing cardiac surgery was underscored by a 1992 study reporting a post cardiac surgery mortality rate up to 28%.…”

Section: Introductionmentioning

confidence: 99%

Heparin-Induced Thrombocytopenia After Mitral Valve Replacement

Tugulan

Chang

Bates

2021

TOJ

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Background: Heparin-induced thrombocytopenia (HIT) is a rare autoimmune reaction that involves a decrease in platelet count following heparin exposure and can be associated with life-threatening thrombosis. Because of their prolonged heparin exposure, patients undergoing cardiac surgery are at risk of HIT, with an incidence of 0.1% to 3%. Case Report: A 65-year-old male with severe mitral regurgitation and preoperative ejection fraction of 20% to 25% underwent mitral valve bioprosthetic replacement with coronary artery bypass graft surgery. Heparin anticoagulation was started on postoperative day (POD) 1. Respiratory failure resulted in prolonged mechanical ventilation and heparinization without the ability to initiate warfarin. While the patient was on heparin, his platelet count declined on POD 2 and then steadily increased to above the preoperative level on POD 7. On POD 10, the patient's platelet count dramatically decreased, and on POD 13 he developed acute common femoral artery occlusion necessitating embolectomy. Intraoperative transesophageal echocardiography revealed heavy thrombus burden across the mitral bioprosthesis. HIT was confirmed with a positive heparin-induced platelet antibody and serotonin release assay. Heparin was stopped and argatroban initiated. The patient underwent reoperative bioprosthetic mitral valve replacement on POD 18 using bivalirudin intraoperatively. Despite resolution of HIT, the patient developed sepsis and died on POD 59. Conclusion: The diagnosis of HIT is challenging in patients who undergo cardiopulmonary bypass. Platelet counts often decrease 40% to 60% during the first 72 hours postoperatively, and the frequency of nonspecific anti–platelet factor 4/heparin antibody formation is high. These findings can mask early signs of HIT and delay diagnosis.

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“…The incidence of HIT in this patient population is reported to be approximately 3%, and it is associated with a 50% increase in mortality and a doubling of the risk of stroke. 1,2 Considering that thromboembolic complications are estimated to be as high as 6.1% per day in patients with undiagnosed HIT, clinicians managing these patients must have a detailed understanding of the disorder to ensure its early recognition, diagnosis, and treatment. 3 Although the incidence and adverse outcomes associated with HIT in patients undergoing cardiac surgery on index admission have been well documented, follow-up data on the incidence of HIT on readmission are scarce.…”

Section: Commentmentioning

confidence: 99%

Heparin-induced thrombocytopenia in patients readmitted after open cardiac surgical procedures: A case series

et al. 2020

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Objectives: Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication that occurs in a small percentage of patients exposed to heparin. Concerns of HIT are particularly high in patients undergoing cardiac procedures requiring cardiopulmonary bypass, as they are exposed to high doses of heparin intraoperatively. Our aim was to identify and assess the hospital courses of patients who were diagnosed with HIT during readmission following cardiac surgery.Methods: A retrospective review of patients who underwent open cardiac surgical procedures from June 2017 through October 2019 was performed. Of these, we identified patients who were newly diagnosed with HIT upon readmission. HIT positivity was defined as a positive anti-PF4 antibody screening test, plus a positive serotonin release assay.Results: Of the 2496 patients identified, 13 patients were HIT positive on index admission and were excluded. Of the remaining 2483 patients, 351 were readmitted within 30 days. Six were newly diagnosed with HIT during readmission, 5 of whom presented with thrombotic complications. One patient was readmitted with thrombocytopenia and was started on argatroban; the remaining 5 did not have a significantly lower platelet count on readmission. Of the 12 patients readmitted for venous thromboembolism, 4 tested positive for HIT.Conclusions: HIT can have a delayed appearance following open heart surgery. Venous thromboembolism appears to be a significant indicator for HIT during readmission, even in the absence of thrombocytopenia. This may support the use of non-heparin anticoagulation for cardiac surgery patients readmitted with thromboembolism until HIT status is determined.

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Heparin-Induced Thrombocytopenia and Cardiac Surgery

Cited by 19 publications

References 41 publications

Heparin-induced thrombocytopenia (HIT): Review of incidence, diagnosis, and management

Heparin-induced thrombocytopenia (HIT): Review of incidence, diagnosis, and management

Heparin-Induced Thrombocytopenia After Mitral Valve Replacement

Heparin-induced thrombocytopenia in patients readmitted after open cardiac surgical procedures: A case series

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