Prevalence of heparin-dependent platelet antibodies in children after cardiopulmonary bypass*

Abstract

The prevalence of HDPA in children after cardiopulmonary bypass surgery is low. After bypass surgery, critically ill children are at risk of developing thrombosis from multiple etiologies, and suspicion of heparin-induced thrombocytopenia needs to be confirmed with laboratory testing including a functional assay.

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…It has been described in pediatric patients but may be less prevalent or less severe. [423][424][425][426] In patients with a recent history of HIT requiring cardiac surgery, alternatives to heparin may be necessary. Alternatives to heparin in pediatric patients undergoing operations with CPB include danaparoid and the direct thrombin inhibitors argatroban and bivalirudin.…”

Systematic review on heparin-induced thrombocytopenia in children: a call to action

“…Nine studies were included for investigation of the primary objective. A total of 335 neonates comprising patients undergoing cardiac surgery, with or without cardio‐pulmonary bypass (CPB), or admitted to a neonatal intensive care unit (NICU), and 558 older children undergoing cardiac surgery (the vast majority under CPB), undergoing hemodialysis or admitted to a pediatric intensive care unit (PICU) were included (Table A,B).…”

“…Four studies were eligible for this particular analysis (Table A). Three studies investigated the presence of anti‐PF4/H antibodies before and after heparin exposure, allowing determination of the incidence of seroconversion, which was found to range from 0% to 1.7%.…”

“…The six included studies reported no cases of HIT among 335 neonates, 250 of whom received prophylactic doses of heparin (i.e. < 10 units kg −1 h −1 ) (Table A).…”

“…Two of the five studies included in this analysis had adequate methodological design to report the incidence of seroconversion. The study conducted by Etches found an incidence of seroconversion of 1.3% (1.7% when considering only post‐cardiac surgery patients) (Table B).…”