Document Detail


Heparin-induced thrombocytopenia with thrombosis syndrome managed with plasmapheresis.
MedLine Citation:
PMID:  19129243     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Heparin-induced thrombocytopenia with thrombosis syndrome is an antibody-mediated disorder that has a high mortality in cardiac surgical patients in spite of early diagnosis and management with direct thrombin inhibitors. Plasmapheresis, an extracorporeal technique that has been designed for the removal of large molecular weight substances from the plasma, can remove the offending antibodies from these desperately ill patients. We describe a case of a postoperative cardiac surgery patient with heparin-induced thrombocytopenia with thrombosis syndrome and multi-system failure who was dependent upon a left ventricular assist device. He was treated successfully with plasmapheresis with recovery of his platelet count from 25,000/microl to over 200,000/microl, along with multi-organ recovery. This patient survived because of plasmapheresis. Removing the antibodies to the heparin-platelet factor four complex with plasmapheresis is an effective strategy to treat these patients. We believe that the use of plasmapheresis as a bail-out procedure in these often desperately ill post-operative cardiac surgical patients who have heparin-induced thrombocytopenia with thrombosis syndrome could be lifesaving.
Authors:
Robert Kramer; Payson Oberg-Higgins; Louis Russo; John H Braxton
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-01-07
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  8     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-23     Completed Date:  2009-06-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  439-41     Citation Subset:  IM    
Affiliation:
Division of Cardiothoracic Surgery, Maine Medical Center, Portland, ME 04102, USA. kramer@mmc.org
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MeSH Terms
Descriptor/Qualifier:
Antibodies / blood
Anticoagulants / adverse effects*,  immunology
Coronary Artery Bypass
Heart-Assist Devices
Heparin / adverse effects*,  immunology
Humans
Male
Middle Aged
Multiple Organ Failure / chemically induced,  therapy
Plasmapheresis*
Syndrome
Thrombocytopenia / chemically induced,  immunology,  therapy*
Thrombosis / chemically induced,  immunology,  therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies; 0/Anticoagulants; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2009 Apr;8(4):441   [PMID:  19304774 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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