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Ann Thorac Surg 2006;81:S2355-S2359
© 2006 The Society of Thoracic Surgeons

Supplement

Recognition and Management of Heparin-Induced Thrombocytopenia in Pediatric Cardiopulmonary Bypass Patients

Lynn K. Boshkov, MD a , * , Aileen Kirby, MD b , Irving Shen, MD b , Ross M. Ungerleider, MD b

a Department of Pathology and Medicine, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon
b Division of Pediatric Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon

* Address correspondence to Dr Boshkov, Division of Hemostasis and Thrombosis, L471 Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97231. (Email: boshkovl{at}ohsu.edu).

Presented at the Symposium on Harnessing the Effects of Neonatal Cardiopulmonary Bypass at the Fourth World Congress of Pediatric Cardiology and Cardiac Surgery, Buenos Aires, Argentina, Sept 21, 2005.

Repeated exposure to unfractionated heparin is the rule in many congenital heart disease patients. Heparin-induced thrombocytopenia occurs in 1% to 3% of adult cardiac surgeries, and carries high thrombotic morbidity (38% to 81%) and mortality (approximately 28%). Although heparin-induced thrombocytopenia appears to be infrequent in pediatric patients, particularly neonates, our evolving experience suggests postcardiopulmonary bypass congenital heart disease patients may be at increased risk. Diagnostic and therapeutic challenges include frequency of thrombocytopenia after cardiopulmonary bypass, imperfect laboratory testing, lack of established dosing of alternative anticoagulants (such as argatroban and lepirudin), and increased anticoagulant-related bleeding in young children.






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