| Incidence of heparin-induced thrombocytopenia and therapeutic strategies in pediatric cardiac surgery. | |
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MedLine Citation:
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PMID: 15620916 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We identified the incidence of heparin-induced thrombocytopenia and the antiheparin-platelet factor 4 (PF4) antibody in pediatric patients undergoing cardiac surgery and documented the differences in the anticoagulation management for the extracorporeal circulation. METHODS: Between January 2001 and September 2003, 559 cardiac procedures with extracorporeal circulation in 415 patients with congenital heart defects were performed in our institution. Because the development of heparin-induced thrombocytopenia requires previous exposition to heparin, only the 144 patients undergoing a scheduled second procedure on extracorporeal circulation were screened preoperatively. Of these 144 patients, 41 underwent also a third procedure and were screened before each procedure for presence of antiheparin-PF4 antibodies and for clinical signs of heparin-induced thrombocytopenia. RESULTS: The incidence of antiheparin-PF4 antibodies during the study period was 1.4% (2 of 144 patients). Patients with clinically significant heparin-induced thrombocytopenia could not be identified. Outside the study protocol, 2 more patients with antiheparin-PF4 antibodies were found. In these 4 patients, surgery was performed using lepirudin (Schering, Berlin, Germany) instead of the usual heparin management for extracorporeal circulation. Three of these 4 patients had an uneventful procedure and postoperative course. In 1 patient after total cavopulmonary connection, a reoperation was necessary on the seventh postoperative day owing to partial thrombosis of the lateral tunnel. CONCLUSIONS: The incidence of heparin-induced thrombocytopenia and of antiheparin-PF4 antibodies in patients undergoing repeated cardiac surgery is low. In antiheparin-PF4 antibody positive patients, the complete avoidance of heparin can be achieved and may account for an uneventful perioperative course. |
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Authors:
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Andreas Böning; Torsten Morschheuser; Udo Bläse; Jens Scheewe; Michael von der Brelie; Ralf Grabitz; Jochen T Cremer |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 79 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2005 Jan |
Date Detail:
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Created Date: 2004-12-28 Completed Date: 2005-08-12 Revised Date: 2006-05-25 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 62-5 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiovascular Surgery, University Hospital Kiel, Hamburg, Germany. aboening@kielheart.uni-kiel.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anticoagulants
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adverse effects*,
contraindications,
immunology Cardiac Surgical Procedures* Extracorporeal Circulation* Heart Defects, Congenital / complications, surgery Heparin / adverse effects*, chemistry, immunology Hirudins / contraindications Humans Incidence Infant Kidney Failure, Chronic / complications Platelet Factor 4 / chemistry, immunology* Postoperative Complications / chemically induced*, epidemiology Preoperative Care Recombinant Proteins / contraindications, therapeutic use Reoperation Retrospective Studies Thrombocytopenia / chemically induced*, epidemiology |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Hirudins; 0/Recombinant Proteins; 0/lepirudin; 37270-94-3/Platelet Factor 4; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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Ann Thorac Surg. 2006 May;81(5):1944; author reply 1944-5
[PMID:
16631722
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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