Preoperative plasmaphereses plus intraoperative heparin for management of cardiac surgery patients with heparin-induced thrombocytopenia (HIT-II)

Heparin-induced thrombocytopenia (HIT) is one of the serious complications in patients who undergo cardiac surgery. However, there remains a major problem in diagnosing HIT because the current immunological assays for detection of HIT antibody have limitations. Furthermore, the clinical course of thrombocytopenia in this surgery makes it increasingly difficult to diagnose HIT. We investigated the relationship between platelet count and HIT antibody in 59 patients who underwent cardiac surgery using cardiopulmonary bypass (CPB). The number of postoperative HIT antibody-positive patients evaluated using enzyme-linked immunosorbent assay kit (polyanion IgG/IgA/IgM complex antibodies/antiplatelet factor 4 enhanced) was 37 (62.7%). In contrast, platelet activation by HIT antibody was evaluated using the serotonin release assay (SRA). More than 20% and 50% release of serotonin was obtained from 12 patients (20.3%) and 8 patients (13.6%), respectively. The levels of d-dimer were significantly different on postoperative day 14 between SRA-positive and SRA-negative groups; however, postoperative thrombus complication was not detected using sonography in the patients with positive serotonin release at all. After being decreased by the operation, their platelet count recovered within 2 weeks in both groups equally. In our study, although the patients were positive in the platelet activating HIT antibody assay, they remained free from thrombosis and their platelet count recovered after early postoperative platelet decrease. Therefore, in addition to the SRA, monitoring of platelet count might be still considered an indispensable factor to facilitate the prediction of HIT thrombosis prior to manifestation in the patients undergoing cardiac surgery using CPB.

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The serological profile of early-onset and persisting post-cardiac surgery thrombocytopenia complicated by “true” heparin-induced thrombocytopenia

Thrombosis and Haemostasis ◽

10.1160/th11-12-0839 ◽

2012 ◽

Vol 107 (05) ◽

pp. 998-1000 ◽

Cited By ~ 2

Author(s):

Jane C. Moore ◽

Susan Vogel ◽

Jo-Ann I. Sheppard ◽

Nathan I. Warkentin ◽

John W. Eikelboom ◽

...

Keyword(s):

Cardiac Surgery ◽

Early Onset ◽

Heparin Induced Thrombocytopenia ◽

Serological Profile ◽

Post Cardiac Surgery

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Impact of obesity on heparin-induced thrombocytopenia in cardiac surgery patients

Blood Coagulation & Fibrinolysis ◽

10.1097/mbc.0000000000000766 ◽

2018 ◽

pp. 1

Author(s):

Anna Vittoria Mattioli ◽

Antonio Manenti ◽

Alberto Farinetti

Keyword(s):

Cardiac Surgery ◽

Heparin Induced Thrombocytopenia

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Usefulness of Danaparoid sodium in patients with Heparin-induced thrombocytopenia after cardiac surgery

Journal of Research in Pharmacy Practice ◽

10.4103/2279-042x.155754 ◽

2015 ◽

Vol 4 (2) ◽

pp. 73 ◽

Cited By ~ 1

Author(s):

Fariborz Farsad ◽

Farzaneh Foroughinia ◽

Kheirollah Gholami ◽

Somayeh Ahmadi

Keyword(s):

Cardiac Surgery ◽

Danaparoid Sodium ◽

Heparin Induced Thrombocytopenia

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A case of heparin induced thrombocytopenia managed by Rivaroxaban

10.22541/au.163815973.39376126/v1 ◽

2021 ◽

Author(s):

Ali Eshraghi ◽

Faeze Keihanian

Keyword(s):

Cardiac Surgery ◽

Oral Anticoagulant ◽

Heparin Induced Thrombocytopenia ◽

Heparin Administration ◽

New Oral Anticoagulant ◽

Increased Risk

Heparin-induced thrombocytopenia (HIT) is an immunogenic disorder. It can lead to thrombocytopenia and a hypercoagulated state with an increased risk for new thrombosis. We here reported a 49-year-old man with previous cardiac surgery and heparin administration, treated by new oral anticoagulant agent, Rivaroxaban.

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Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report

10.21203/rs.3.rs-34909/v3 ◽

2020 ◽

Author(s):

Joseph F. Ferry ◽

Samuel Youssef ◽

Pierce Wu ◽

Livia Hegerova

Keyword(s):

Emergency Department ◽

Cardiac Surgery ◽

Splenic Vein ◽

Adrenal Hemorrhage ◽

Right Atrial ◽

Splenic Vein Thrombosis ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Bilateral Adrenal Hemorrhage ◽

The Right

Abstract Background: Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5-10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5-10%.Case presentation: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department on day nine following coronary artery bypass graft surgery with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi.Conclusions: Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery.

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Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report

10.21203/rs.3.rs-34909/v1 ◽

2020 ◽

Author(s):

Joseph Frank Ferry ◽

Samuel Youssef ◽

Pierce Wu ◽

Livia Hegerova

Keyword(s):

Emergency Department ◽

Cardiac Surgery ◽

Splenic Vein ◽

Adrenal Hemorrhage ◽

Right Atrial ◽

Splenic Vein Thrombosis ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Bilateral Adrenal Hemorrhage ◽

The Right

Abstract Background Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5–10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5–10%. Case presentation: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi. Conclusions Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery.

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