Heparin-induced thrombocytopenia in patients receiving mechanical circulatory support

Abstract

Heparin-induced thrombocytopenia was more prevalent in patients receiving mechanical circulatory support than in other cardiac patients. Frequent antibody screening is recommended due to the increased risk of thromboembolism. Heparin alternatives should be subjected to clinical trials in these high-risk patients.

Heparin-Induced Thrombocytopenia: Frequency and Pathogenesis

“…These patients had no increased risk for new thrombosis as compared to HIT antibody negative patients. [76] Although the first report that anti-IL8 and anti-NAP-2 antibodies can induce HIT [77] was later confirmed [78], little additional evidence has been reported which allows to estimate the prevalence of these antibodies in HIT patients.…”

Heparin-induced thrombocytopenia in intensive care patients

“…One of these studies (38) showed that including detection of IgM and IgA antibodies worsened test operating characteristics (reduced specificity without improved sensitivity). In a recent study of Ͼ100 patients on cardiac assist devices, we provided further evidence for a strong correlation between a positive functional test and high risk for thrombosis, whereas the thrombotic risk of patients who were positive only in the antigen assay did not differ from those who were antibody-negative (41).…”

Cardiac transplantation and/or mechanical circulatory support device placement using heparin anti-coagulation in the presence of acute heparin-induced thrombocytopenia

“…As such, many of these individuals will test positive for Hep/PF4 antibodies by ELISA. 19 In these patients, CPB, required at the time of transplantation or VAD placement, becomes problematic as conventional wisdom, hospital/pharmacy policies, and legal considerations discourage the use of heparin in the presence of an "allergy" to heparin.…”