Document Detail


Impact of heparin-induced thrombocytopenia on outcome in patients with ventricular assist device support: single-institution experience in 358 consecutive patients.
MedLine Citation:
PMID:  17184633     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac surgical patients are at an approximate 1% to 2% risk of experiencing heparin-induced thrombocytopenia (HIT), a severe immune-mediated disease that is associated with thromboembolic events. We assessed the occurrence of this disease and its influence on clinical outcome in patients after implantation of a ventricular assist device (VAD). METHODS: This retrospective analysis assessed data from our adult patient VAD program between the years 2000 and 2005. Patients were divided into three groups: those without confirmed HIT ((non)HIT), those in whom the diagnosis of HIT was made before VAD implantation (HIT(pre)), and those who experienced HIT after VAD implantation (HIT(post)). End points assessed were procedural success, as defined by discharge from hospital or transplantation or recovery of the failing heart, as opposed to death before procedural success was achieved. RESULTS: The data of 358 consecutive patients were analyzed. There were 330 (non)HIT patients (91.6%), 15 HIT(pre) patients (4.5%), and 13 HIT(post) patients (3.9%). Procedural success was observed in 50% of (non)HIT patients, 67% of HIT(pre) patients, and 31% of HIT(post) patients. CONCLUSIONS: Heparin-induced thrombocytopenia is a frequent complication in VAD patients and is associated with detrimental outcome when occurring after implantation. Preoperative diagnosis of HIT and the implementation of alternative anticoagulation procedures appears to be associated with better results. Early detection of HIT antibodies before or shortly after VAD implantation and immediate implementation of an alternative anticoagulation regimen may be a strategy to improve outcome.
Authors:
Andreas Koster; Sabine Huebler; Evgenij Potapov; Oliver Meyer; Michael Jurmann; Yuguo Weng; Miralem Pasic; Thorsten Drews; Hermann Kuppe; Matthias Loebe; Roland Hetzer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-22     Completed Date:  2007-01-04     Revised Date:  2008-01-25    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  72-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia, Deutsches Herzzentrum Berlin, Germany. koster@dhzb.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anticoagulants / adverse effects*
Female
Heart-Assist Devices / adverse effects*
Heparin / adverse effects*
Humans
Male
Middle Aged
Thrombocytopenia / chemically induced*,  diagnosis
Chemical
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Ann Thorac Surg. 2008 Jan;85(1):360-1; author reply 361   [PMID:  18154856 ]
Ann Thorac Surg. 2007 Jan;83(1):21-3   [PMID:  17184624 ]
Ann Thorac Surg. 2007 Oct;84(4):1422-3; author reply 1423-4   [PMID:  17889024 ]

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