Heparin‐induced thrombocytopenia and thrombosis in primary lymphedema patients who underwent vascularized lymph node transplantations

Abstract

BackgroundHeparin‐induced thrombocytopenia and thrombosis (HITT) may result in microsurgical flap failure. This study investigated the outcomes of HITT in primary lymphedema patients who underwent vascularized lymph node transplantations (VLNT).MethodsBetween 2012 and 2019, primary lymphedema patients who underwent VLNTs were retrospectively included. The 4Ts score was used to categorize patients into HITT (scores of 5–7) and non‐HITT (score < 5) groups. Outcome evaluations included the re‐exploration rate, success rate, circumferential differences, cellulitis episodes, and Lymphedema Specific Quality of Life Questionnaire (LYMQoL) scores.ResultsTwenty‐six and 15 patients with 31 and 16 VLNTs were included in the HITT and non‐HITT groups, respectively. The HITT group had significantly greater first, second and third re‐exploration rates of 38.7% (12/31), 25.7% (8/31), and 6.5% (2/31) than the non‐HITT group (6.3%, 0%, and 0%, all p < 0.01), respectively. The platelet counts significantly decreased by 21.0% in the HITT group compared with the non‐HITT group (14%) on postoperative Day one (p < 0.01) with a cutoff value of 17% and AUC = 0.88.ConclusionsHITT may cause a high re‐exploration rate of VLNTs in primary lymphedema patients. The 17% reduction in platelets on postoperative day one was an early sign for detecting HITT.

Current Concepts in the Management of Primary Lymphedema

“…Others have reported that following VLNT, complete normalization of limb volume is achievable in 20% of patients [ 6 ]. Patients with primary lymphedema who undergo VLNT may be at an increased risk of developing heparin-induced thrombocytopenia and thrombosis (HITT), which increases the risk of flap complications [ 50 ]. Case series have suggested that combining VLNT with lipectomy may improve limb circumference and patient satisfaction [ 30 ].…”