Presentation, management and outcome of heparin-induced thrombocytopenia after valvular heart surgery.

Abstract

OBJECTIVES:

The use of heparin exposes patients to heparin-induced thrombocytopenia, which is a challenging issue for both diagnosis and patient management. We sought to describe the clinical presentation, management and outcome of a series of patients diagnosed with heparin-induced thrombocytopenia after heart valve surgery.

METHODS:

All consecutive patients diagnosed with heparin-induced thrombocytopenia during the postoperative period of heart valve surgery over a 6-year period were prospectively enrolled in a single-centre registry. Clinical and biological data were collected. In-hospital and mid-term outcomes were assessed. Information regarding the occurrence of all medical events including death, recurrence of thromboembolic events and/or thrombocytopenia was collected.

RESULTS:

We identified 93 patients (incidence proportion = 2.8%). Most patients (82%) were asymptomatic with isolated thrombocytopenia at the time of diagnosis. The other main circumstance of diagnosis was the occurrence of thromboembolic events in 17 patients (6 strokes, 10 prosthetic valve thrombosis and 1 peripheral embolic event). The in-hospital mortality rate was 1%. No thrombolysis, interventional procedure or redo surgery was performed. Danaparoid sodium was used as heparin replacement therapy in most cases (96%) and leading to complete and uneventful thrombus resolution in all cases with only one possibly related major bleeding complication. During a mean follow-up of 36 ± 20 months, no patient presented recurrence of any heparin-induced thrombocytopenia-related complication.

CONCLUSIONS:

In this contemporary series of patients, heparin-induced thrombocytopenia incidence was low and isolated thrombocytopenia was the most frequent presentation. Conservative management with early diagnosis and substitutive anticoagulation therapy introduction was associated with a low rate of clinical events and a remarkably good outcome with a low mortality rate.

• Authors: Dimitri Arangalage, Laurent Lepage, Dorothée Faille, Claire Cimadevilla, Marie-Pierre Dilly, Emmanuelle Papy, Martine Alhenc-Gelas, Walid Ghodbane, Patrick Nataf, Bernard Iung, Philippe Gabriel Steg, Alec Vahanian, Nadine Ajzenberg, David Messika-Zeitoun
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 50 Issue 6 Pg. 1132-1138 (Dec 2016) ISSN: 1873-734X [Electronic] Germany
• PMID: 27301386 (Publication Type: Journal Article)
• Copyright: © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Chemical References

• Anticoagulants
• Heparin

Topics

• Anticoagulants (therapeutic use)
• Cardiac Surgical Procedures (adverse effects, methods)
• Echocardiography
• Female
• Heart Valves (surgery)
• Heparin (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Platelet Count
• Postoperative Period
• Prospective Studies
• Registries
• Thrombocytopenia (chemically induced, diagnosis, drug therapy)
• Thromboembolism (etiology)