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Ann Thorac Surg 2005;79:62-65
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Incidence of Heparin-Induced Thrombocytopenia and Therapeutic Strategies in Pediatric Cardiac Surgery

^a Department of Cardiovascular Surgery, University Hospital Kiel, Hamburg, Germany
^b Department of Pediatric Cardiology, University Hospital Kiel, Hamburg, Germany
^c Department of Cardiology, Albertinen-Hospital, Hamburg, Germany

Accepted for publication July 6, 2004.

^* Address reprint requests to Dr Böning, Department of Cardiovascular Surgery, University Hospital, Arnold-Heller-Str 7, 24105 Kiel, Germany (E-mail: aboening{at}kielheart.uni-kiel.de).

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.

This article has been cited by other articles:

				F. Newall, V. Ignjatovic, and P. Monagle Temporal aspects of anti-heparin-PF4 antibodies in heparin-induced thrombocytopenia. Ann. Thorac. Surg., May 1, 2006; 81(5): 1944 - 1944. [Full Text] [PDF]

				A. Boning and J. T. Cremer Reply. Ann. Thorac. Surg., May 1, 2006; 81(5): 1944 - 1945. [Full Text] [PDF]