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The Annals of Thoracic Surgery, Vol 53, 787-791, Copyright © 1992 by The Society of Thoracic Surgeons
JT Walls, JJ Curtis, D Silver, TM Boley, RA Schmaltz and W Nawarawong
Most patients undergoing open heart operations have had exposure to heparin
for diagnostic and/or therapeutic procedures. Heparin antibody formation
and heparin-induced thrombocytopenia with repeat heparin administration can
cause high morbidity and mortality from thrombotic complications,
especially when delay in diagnosis occurs. From 1981 to 1991,
heparin-induced thrombocytopenia was diagnosed in 82 of 4,261 open heart
surgical patients (1.9%). Platelet counts less than 100 x 10(9)/L
(100,000/microL) or new or recurring thrombotic events prompted suspicion
of heparin-induced thrombocytopenia. Heparin-dependent antibody was
diagnosed preoperatively in 12 patients (group I) and postoperatively in 70
patients (group II). Heparin was not given postoperatively in group I
patients, and complications in this group were limited to bleeding in 3
patients. There were no thromboembolic events and all patients survived.
Group II patients had late recognition of heparin-dependent antibody
postoperatively, and heparin exposure was continued for varying periods
postoperatively. Thirty- seven group II patients (53%) had bleeding
complications and 31 (44%) had thromboembolic complications. These
complications led to death in 23 group II patients (33%). Heparin-dependent
antibody may occur in patients having open heart operations and is a major
cause of morbidity and mortality if not diagnosed early with cessation of
heparin therapy.
ARTICLES
Heparin-induced thrombocytopenia in open heart surgical patients: sequelae of late recognition
Division of Cardiothoracic, University of Missouri, Columbia 65212.
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