Postoperative Thrombotic Thrombocytopenic Purpura After Open Heart Operations

Saltzman, Darin J.; Chang, Jae C.; Jiménez, Juan Carlos; Carson, John G.; Abolhoda, Amir; Newman, Richard; Milliken, Jeffrey C.

doi:10.1016/j.athoracsur.2009.09.019

Cited by 36 publications

(29 citation statements)

References 32 publications

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“…These authors hypothesized that pTTP could be caused by an insufficient protein C-dependent anticoagulant pathway as a result of decreased thrombomodulin levels and the release of ULVWF multimers in high amounts, both due to endothelial damage. Saltzman et al [11] reported reduced levels of ADAMTS-13 activity in four patients with surgery-associated TMA but did not detect antibodies against ADAMTS-13, therefore suggesting a nonimmune-mediated mechanism.…”

Section: Discussionmentioning

confidence: 95%

“…However, two study groups reported decreased activity levels in connection with cardiac surgery-associated TMA [11,14,14,31]. Saltzman et al [11] reported five patients presenting with TMA following CABG. All of the patients had postoperative low platelet counts, haemolytic anaemia and more than 1% schistocytes on postoperative blood smears.…”

Section: Discussionmentioning

confidence: 98%

“…TMAs have been reported in connection with different surgical procedures, including cardiovascular surgery [11][12][13][14][15][16]. Chang et al [13] were the first to report TMA in association with cardiovascular surgery; they reported eight cases of cardiac surgery-associated TMA [three coronary artery bypass graft (CABG), two CABG þ mitral valve operation, two peripheral vascular surgery, one resection of myocardial sarcoma].…”

Section: Introductionmentioning

confidence: 99%

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Prospective evaluation of ADAMTS-13 and von Willebrand factor multimers in cardiac surgery

Reinecke

Weber

Budde

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Acquired thrombotic-thrombocytopenic purpura, one of the main representatives of thrombotic microangiopathies (TMAs), is caused by the accumulation of antibodies against ADAMTS-13. Several cases of postoperative TMAs have been observed during the past few years, but the pathogenesis remains unknown. In addition to this, it is unclear whether the use of extracorporeal circulation (ECC) during cardiac surgery has an influence on the occurrence of cardiac surgery-associated TMA. In this study, we investigated the relationship between ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type 1 motifs 13), ADAMTS-13 inhibitor, von Willebrand factor (VWF) and large VWF multimers in cardiac surgery with and without the use of ECC. Blood samples were taken preoperatively, intraoperatively and up to 6 days postoperatively. A total of 47 patients (median age 70 years, 18 women, 29 men) undergoing cardiac surgery were included; cardiac surgery with the use of ECC (cardiopulmonary bypass) was used in 39 patients, and the off-pump coronary artery bypass technique was used in eight patients. TMA was not diagnosed in any of the patients. Cardiac surgery led to a significantly reduced ADAMTS-13 activity (from 67 to 51%, P < 0.001 in the cardiopulmonary bypass group, from 64 to 48%, P = 0.02 in the off-pump coronary artery bypass group) and higher amounts of large VWF multimers. Development of ADAMTS-13 antibodies was not induced by cardiac surgery. Cardiac surgery led to a slight but significant decrease of ADAMTS-13, but this decrease was not associated with TMA.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prospective evaluation of ADAMTS-13 and von Willebrand factor multimers in cardiac surgery

Reinecke

Weber

Budde

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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“…The author speculated that the pathogenesis of postoperative TTP is massive endothelial damage during surgery with release of ultra-large multimers of von Willebrand factor, which overwhelmed the cleaving protease activity. More cases of postoperative TTP are being described in the adult literature, adding to the accumulative data about the unique syndrome in adults [14].…”

Section: Discussionmentioning

confidence: 98%

Postoperative thrombotic thrombocytopenic purpura in an infant: case report and literature review

Schiller

Ash

Schonfeld

et al. 2011

Journal of Pediatric Surgery

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“…1 The occurrence of TTP after surgery is a rare clinical syndrome with considerable similarity to classic TTP in presentation. TTP has been described following vascular surgery, 3,4 coronary artery bypass grafting, 3,5 orthopedic surgery, 6,7 transurethral resection of the prostate, 1 abdominal surgeries, [8][9][10] and gynecologic cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

Acute Thrombotic Thrombocytopenic Purpura Following Orthopedic Surgery: Case Report and Review of the Literature

et al. 2012

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Thrombotic thrombocytopenic purpura (TTP) is an uncommon cause of hematological and renal abnormalities in the postoperative period. An association between TTP and orthopedic surgery, a rare entity, has been reported in the literature. It has the strong possibility of being fatal and therefore should be treated immediately, mostly by plasmapheresis. We report a 15-year-old girl of TTP following a high tibial valgus osteotomy (HTO).

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Postoperative Thrombotic Thrombocytopenic Purpura After Open Heart Operations

Cited by 36 publications

References 32 publications

Prospective evaluation of ADAMTS-13 and von Willebrand factor multimers in cardiac surgery

Prospective evaluation of ADAMTS-13 and von Willebrand factor multimers in cardiac surgery

Postoperative thrombotic thrombocytopenic purpura in an infant: case report and literature review

Acute Thrombotic Thrombocytopenic Purpura Following Orthopedic Surgery: Case Report and Review of the Literature

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