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. 2007 Jan;83(1):72-6.
doi: 10.1016/j.athoracsur.2006.05.077.

Impact of heparin-induced thrombocytopenia on outcome in patients with ventricular assist device support: single-institution experience in 358 consecutive patients

Andreas Koster  1 , Sabine Huebler, Evgenij Potapov, Oliver Meyer, Michael Jurmann, Yuguo Weng, Miralem Pasic, Thorsten Drews, Hermann Kuppe, Matthias Loebe, Roland Hetzer
Affiliations

Impact of heparin-induced thrombocytopenia on outcome in patients with ventricular assist device support: single-institution experience in 358 consecutive patients

Andreas Koster et al. Ann Thorac Surg. 2007 Jan.

Abstract

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 (HIT(pre)), and those who experienced HIT after VAD implantation (HIT(post)). 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 330 (non)HIT patients (91.6%), 15 HIT(pre) patients (4.5%), and 13 HIT(post) patients (3.9%). Procedural success was observed in 50% of (non)HIT patients, 67% of HIT(pre) patients, and 31% of HIT(post) 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.

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Comment in

  • When is HIT really HIT?
    Warkentin TE, Crowther MA. Warkentin TE, et al. Ann Thorac Surg. 2007 Jan;83(1):21-3. doi: 10.1016/j.athoracsur.2006.07.006. Ann Thorac Surg. 2007. PMID: 17184624 No abstract available.
  • HIT in VAD patients: considerations.
    Lappa A, Picozzi P, D'Avino E, Riondino S, Menichetti A, Musumeci F. Lappa A, et al. Ann Thorac Surg. 2007 Oct;84(4):1422-3; author reply 1423-4. doi: 10.1016/j.athoracsur.2007.04.087. Ann Thorac Surg. 2007. PMID: 17889024 No abstract available.
  • Ventricular assist device implantation and the risk for heparin-induced thrombocytopenia.
    Barzaghi N, Locatelli A, Ranucci M. Barzaghi N, et al. Ann Thorac Surg. 2008 Jan;85(1):360-1; author reply 361. doi: 10.1016/j.athoracsur.2007.06.010. Ann Thorac Surg. 2008. PMID: 18154856 No abstract available.

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