HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mani A. Daneshmand Rebecca P. Petersen Andrew J. Lodge Carmelo A. Milano Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schroder, J. N. Articles by Milano, C. A. Search for Related Content PubMed PubMed Citation Articles by Schroder, J. N. Articles by Milano, C. A. Related Collections Transplantation - heart

Ann Thorac Surg 2007;84:841-846
© 2007 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Heparin-Induced Thrombocytopenia in Left Ventricular Assist Device Bridge-to-Transplant Patients

^a Department of Surgery, Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
^b Department of Anesthesiology, Division of Cardiac Anesthesia, Duke University Medical Center, Durham, North Carolina
^c Department of Medicine, Division of Hematology, Duke University Medical Center, Durham, North Carolina
^d Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina

Accepted for publication March 19, 2007.

^_* Address correspondence to Dr Milano, Box 3043, Department of Surgery, Duke University Medical Center, Durham, NC 27703 (Email: milan002{at}mc.duke.edu).

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.

Background: The presence of heparin-induced thrombocytopenia (HIT) increases the risk for thromboembolic events in ventricular assist device (VAD) patients undergoing transplantation. However, cardiopulmonary bypass with alternative anticoagulants is often complicated by bleeding. Owing to this concern, we compared outcomes of HIT-positive versus control bridge-to-transplantation VAD patients; both groups were reexposed to heparin for cardiopulmonary bypass during transplant.

Methods: From February 2000 to January 2006, data were reviewed on 92 consecutive adult patients who underwent VAD placement as a bridge to transplantation. Patients in whom thrombocytopenia developed after heparin exposure were tested for HIT with an enzyme-linked immunosorbent assay for antiheparin/platelet factor-4 (HPF4) antibody (GTI Diagnostics, Waukesha, Wisconsin). During VAD support, heparin was avoided in HIT-positive patients, but all patients were reexposed to heparin during transplantation. Comparisons between HIT-positive and control patients for survival and freedom from thromboembolic events were determined using the Kaplan-Meier method and log-rank test. Continuous and categorical variables were compared using the Wilcoxon rank-sum and Student t test.

Results: Twenty-four of the 92 patients (26.1%) were determined to be HIT positive by enzyme-linked immunosorbent assay. Survival to transplant was not different between the two groups. When compared with control patients, HIT-positive patients who were reexposed to heparin had a greater decrease in platelet counts immediately after transplant (postoperative days 1 to 4, p < 0.05). Despite this transient thrombocytopenia, there was no difference in posttransplant mortality or thromboembolism.

Conclusions: Heparin-induced thrombocytopenia–positive VAD patients did not experience increased thromboembolism or mortality after heparin reexposure. In light of the risks of using heparin alternatives, heparin reexposure is a safe management strategy for HIT-positive VAD patients.

This article has been cited by other articles:

				G. J. Weiss, L. W. Miller, and F. D. Pagani Continuous-Flow Ventricular Assist Device N. Engl. J. Med., November 29, 2007; 357(22): 2305 - 2306. [Full Text] [PDF]