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Heparin-induced thrombocytopenia in left ventricular assist device bridge-to-transplant patients.

Publication ,  Journal Article
Schroder, JN; Daneshmand, MA; Villamizar, NR; Petersen, RP; Blue, LJ; Welsby, IJ; Lodge, AJ; Ortel, TL; Rogers, JG; Milano, CA
Published in: Ann Thorac Surg
September 2007

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.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

September 2007

Volume

84

Issue

3

Start / End Page

841 / 845

Location

Netherlands

Related Subject Headings

  • Thromboembolism
  • Thrombocytopenia
  • Retrospective Studies
  • Respiratory System
  • Platelet Factor 4
  • Platelet Count
  • Middle Aged
  • Male
  • Humans
  • Heparin
 

Citation

APA
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ICMJE
MLA
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Schroder, J. N., Daneshmand, M. A., Villamizar, N. R., Petersen, R. P., Blue, L. J., Welsby, I. J., … Milano, C. A. (2007). Heparin-induced thrombocytopenia in left ventricular assist device bridge-to-transplant patients. Ann Thorac Surg, 84(3), 841–845. https://doi.org/10.1016/j.athoracsur.2007.03.049
Schroder, Jacob N., Mani A. Daneshmand, Nestor R. Villamizar, Rebecca P. Petersen, Laura J. Blue, Ian J. Welsby, Andrew J. Lodge, Thomas L. Ortel, Joseph G. Rogers, and Carmelo A. Milano. “Heparin-induced thrombocytopenia in left ventricular assist device bridge-to-transplant patients.Ann Thorac Surg 84, no. 3 (September 2007): 841–45. https://doi.org/10.1016/j.athoracsur.2007.03.049.
Schroder JN, Daneshmand MA, Villamizar NR, Petersen RP, Blue LJ, Welsby IJ, et al. Heparin-induced thrombocytopenia in left ventricular assist device bridge-to-transplant patients. Ann Thorac Surg. 2007 Sep;84(3):841–5.
Schroder, Jacob N., et al. “Heparin-induced thrombocytopenia in left ventricular assist device bridge-to-transplant patients.Ann Thorac Surg, vol. 84, no. 3, Sept. 2007, pp. 841–45. Pubmed, doi:10.1016/j.athoracsur.2007.03.049.
Schroder JN, Daneshmand MA, Villamizar NR, Petersen RP, Blue LJ, Welsby IJ, Lodge AJ, Ortel TL, Rogers JG, Milano CA. Heparin-induced thrombocytopenia in left ventricular assist device bridge-to-transplant patients. Ann Thorac Surg. 2007 Sep;84(3):841–845.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

September 2007

Volume

84

Issue

3

Start / End Page

841 / 845

Location

Netherlands

Related Subject Headings

  • Thromboembolism
  • Thrombocytopenia
  • Retrospective Studies
  • Respiratory System
  • Platelet Factor 4
  • Platelet Count
  • Middle Aged
  • Male
  • Humans
  • Heparin