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a Clinical Research Unit, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
b Department of Biostatistics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
Accepted for publication May 30, 2007.
* Address correspondence to Dr Lattouf, Crawford Long Hospital, 6th Floor, Medical Office Tower, Atlanta, GA 30308. (Email: omar.lattouf{at}emoryhealthcare.org).
Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.
Background: The objectives of this study are to determine the effect of heparin-induced thrombocytopenia (HIT) on postoperative morbidity and mortality after cardiac surgery and to identify preoperative risk factors for HIT.
Methods: From 2002 to 2005, 487 cardiac surgery patients with postoperative thrombocytopenia (50% drop in platelet count or absolute count < 100,000/µL) underwent at least one enzyme-linked immunosorbent assay for HIT platelet factor 4 antibodies. Risk factors and outcomes of patients with a positive HIT assay (HIT+) were compared with patients with thrombocytopenia, but without HIT antibodies (HIT-).
Results: 23.2% of patients (113 of 487) were HIT+. Multivariable predictors of HIT included previous percutaneous coronary interventions (odds ratio [OR] = 1.76, p = 0.03), class IV New York Heart Association heart failure (OR = 1.80, p = 0.012), and infectious endocarditis (OR = 3.66, p = 0.0123). Postoperative infections occurred more frequently in HIT+ patients, including sepsis (16.8% versus 9.9%, p = 0.0433) and pneumonia (46.9% versus 23.3 %, p < 0.001). The HIT+ patients also had a higher rate of renal failure requiring hemodialysis (23.0% versus 9.1%, p < 0.001) and acute limb ischemia (15.9% versus 4.3%, p < 0.001). Thirty-day mortality was significantly higher in the HIT+ group (24.8% versus 15.2%, p = 0.019). Postoperative HIT emerged as an independent predictor of renal failure (OR = 1.73, p < 0.001) and thromboembolic complications (OR = 2.39, p = 0.02).
Conclusions: Heparin-induced thrombocytopenia patients are at significantly greater risk of thrombosis, renal failure, and mortality in the postoperative setting. Greater awareness of this devastating problem may allow earlier detection of HIT, with prompt institution of appropriate anticoagulation therapy, which could potentially limit the associated morbidity and mortality.
This article has been cited by other articles:
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  A V Mattioli, L Bonetti, U Carletti, G Ambrosio, and G Mattioli Thrombotic events in patients with antiplatelet factor 4/heparin antibodies Heart, August 15, 2009; 95(16): 1350 - 1354. [Abstract] [Full Text] [PDF]
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 E. Shantsila, G. Y. H. Lip, and B. H. Chong Heparin-Induced Thrombocytopenia: A Contemporary Clinical Approach to Diagnosis and Management Chest, June 1, 2009; 135(6): 1651 - 1664. [Abstract] [Full Text] [PDF]
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 F. Pappalardo, A. Greinacher, and S. Selleng Postoperative Complications After Cardiac Surgery and HIT: A Word of Caution Ann. Thorac. Surg., September 1, 2008; 86(3): 1054 - 1055. [Full Text] [PDF]
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F. Kerendi, V. H. Thourani, J. D. Puskas, R. A. Guyton, and O. M. Lattouf Reply Ann. Thorac. Surg., September 1, 2008; 86(3): 1055 - 1055. [Full Text] [PDF]
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 K. Knobloch, A. Gohritz, M. Spies, and P. M. Vogt HIT in OPCAB surgery Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 382 - 382. [Full Text] [PDF]
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