Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass

Abstract

Heparin-induced thrombocytopenia (HIT) is an immune-mediated response to heparin administration. HIT following cardiopulmonary bypass (CPB) procedures has not been clearly delineated in pediatric populations. By comprehensive retrieval of the pertinent literature published since 2000, 19 reports were collected with 33 pediatric patients recruited into this study. A female predominance was noted in this patient setting. HIT occurred after a mean heparin exposure of 2.8 times. Pediatric HIT following CPB showed different features from that with no CPB, by a longer span on postoperative day 1-16, and a significant negative correlation between the platelet count and time of occurrence of thrombocytopenia on postoperative day 1-8. The thrombus formation developed on postoperative day 13. Heparin discontinuation and use of coganulant substitute are the important treatments of choice. In HIT patients, continued heparin use may cause patient death or recurrence of HIT. HIT-related thrombosis was present in 69.6% of the patients with similar incidence rates of arterial and venous thrombosis; and the thrombosis could be managed by medical, surgical or device explant methods. The direct thrombin inhibitors lepirudin, argatroban and bivalirudin as well as the factor Xa inhibitor danaparoid can be used safely in most of the pediatric patients. The event-free survival rate of this patient setting was 69.7%.

Heparin Induced Thrombocytopenia – Pathophysiology, Diagnosis and Treatment: A Narrative Review

“…The mainstay of management for patients who have been confirmed to be suffering from HIT is immediate cessation of heparin therapy followed by administration of alternative anticoagulant treatment depending on the thrombotic status of the patient. 43 In patients who have been classified as having intermediate or high risk based on their 4T score, heparin therapy should definitely be discontinued. Cessation of unfractionated heparin is deficient to prevent the occurrence of thrombotic events and an alternative anticoagulant medication should be provided to the patient, with the exception of both LMWH or warfarin, which can conversely induce the generation of thrombin and further escalate the risk for thrombosis.…”

Hemostatic Challenges in Pediatric Critical Care Medicine—Hemostatic Balance in VAD

“…In a single institution experience in 54 children placed on ECLS for a total of 56 runs, Bivalirudin use showed no differences in outcomes compared to heparin, however resulted in longer freedom from first circuit intervention (55). Bivalirudin has also been used safely in pediatric in cases of contraindications to heparin (i.e., HIT) (56) or when unreliable heparin monitoring exists (i.e., severe hemolysis and hyperbilirubinemia) (57). The DTI experience in children is growing.…”