Impact of Heparin-Induced Thrombocytopenia on Outcome in Patients with Ventricular Assist Device Support: Single-Institution Experience in 358 Consecutive Patients

• Published in: The Annals of thoracic surgery Vol. 83; no. 1; pp. 72 - 76
• Main Authors: Koster, Andreas, MD, Huebler, Sabine, MD, Potapov, Evgenij, MD, Meyer, Oliver, MD, Jurmann, Michael, MD, Weng, Yuguo, MD, Pasic, Miralem, MD, Drews, Thorsten, MD, Kuppe, Hermann, MD, Loebe, Matthias, MD, Hetzer, Roland, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2007; Elsevier Science
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - adverse effects; Biological and medical sciences; Cardiothoracic Surgery; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Heart-Assist Devices - adverse effects; Heparin - adverse effects; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; Thrombocytopenia - chemically induced; Thrombocytopenia - diagnosis; 27; Artificial heart; Human; Intensive cardiocirculatory care; Prognosis; Support; Respiratory disease; Toxicity; Artificial ventricle; Cardiocirculatory support; Patient; Anticoagulant; Thorax; Institution; Experience; Treatment; Surgery; Auxiliary ventricule; Glycosaminoglycan; Complication; Evolution; Heparin
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.05.077

Background Cardiac surgical patients are at an approximate 1% to 2% risk of experiencing heparin-induced thrombocytopenia (HIT), a severe immune-mediated disease that is associated with thromboembolic events. We assessed the occurrence of this disease and its influence on clinical outcome in patients after implantation of a ventricular assist device (VAD). Methods This retrospective analysis assessed data from our adult patient VAD program between the years 2000 and 2005. Patients were divided into three groups: those without confirmed HIT (non HIT), those in whom the diagnosis of HIT was made before VAD implantation (HITpre ), and those who experienced HIT after VAD implantation (HITpost ). End points assessed were procedural success, as defined by discharge from hospital or transplantation or recovery of the failing heart, as opposed to death before procedural success was achieved. Results The data of 358 consecutive patients were analyzed. There were 330non HIT patients (91.6%), 15 HITpre patients (4.5%), and 13 HITpost patients (3.9%). Procedural success was observed in 50% ofnon HIT patients, 67% of HITpre patients, and 31% of HITpost patients. Conclusions Heparin-induced thrombocytopenia is a frequent complication in VAD patients and is associated with detrimental outcome when occurring after implantation. Preoperative diagnosis of HIT and the implementation of alternative anticoagulation procedures appears to be associated with better results. Early detection of HIT antibodies before or shortly after VAD implantation and immediate implementation of an alternative anticoagulation regimen may be a strategy to improve outcome.