HEPARIN-INDUCED THROMBOCYTOPENIA IN OPEN-HEART SURGICAL PATIENTS - SEQUELAE OF LATE RECOGNITION

被引:95
作者
WALLS, JT [1 ]
CURTIS, JJ [1 ]
SILVER, D [1 ]
BOLEY, TM [1 ]
SCHMALTZ, RA [1 ]
NAWARAWONG, W [1 ]
机构
[1] UNIV MISSOURI,DIV VASC SURG,COLUMBIA,MO 65212
关键词
D O I
10.1016/0003-4975(92)91437-E
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Most patients undergoing open heart operations have had exposure to heparin for diagnostic and/or therapeutic procedures. Heparin antibody formation and heparin-induced thrombocytopenia with repeat heparin administration can cause high morbidity and mortality from thrombotic complications, especially when delay in diagnosis occurs. From 1981 to 1991, heparin-induced thrombocytopenia was diagnosed in 82 of 4,261 open heart surgical patients (1.9%). Platelet counts less than 100 X 10(9)/L (100,000/mu-L) or new or recurring thrombotic events prompted suspicion of heparin-induced thrombocytopenia. Heparin-dependent antibody was diagnosed preoperatively in 12 patients (group I) and postoperatively in 70 patients (group II). Heparin was not given postoperatively in group I patients, and complications in this group were limited to bleeding in 3 patients. There were no thromboembolic events and all patients survived. Group II patients had late recognition of heparin-dependent antibody postoperatively, and heparin exposure was continued for varying periods postoperatively. Thirty-seven group II patients (53%) had bleeding complications and 31 (44%) had thromboembolic complications. These complications led to death in 23 group II patients (33%). Heparin-dependent antibody may occur in patients having open heart operations and is a major cause of morbidity and mortality if not diagnosed early with cessation of heparin therapy.
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页码:787 / 791
页数:5
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