Heparin-induced thrombocytopenia in the presence of a heparin-bonded bypass graft

Vascular ◽  
2011 ◽  
Vol 19 (6) ◽  
pp. 338-341 ◽  
Author(s):  
M D Wheatcroft ◽  
E Greco ◽  
L Tse ◽  
G Roche-Nagle
Keyword(s):  
Vascular Graft ◽  
Graft Failure ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Autologous Vein ◽  
Heparin Induced Thrombocytopenia ◽  
Graft Removal ◽  
Early Graft ◽  
Expanded Polytetrafluoroethylene Graft ◽  
Early Graft Failure

The use of prosthetic grafts in below-knee bypasses may be necessary in patients with no available autologous vein and critical limb ischemia not amenable to angioplasty. Such conduits, however, have generally yielded disappointing results. A new, heparin-bonded, expanded polytetrafluoroethylene graft (Gore Propaten vascular graft) designed to provide resistance to thrombosis may be associated with decreased early graft failure and increased patency. A concern with exposure to heparin, and therefore heparin-bonded prostheses, is the development of heparin-induced thrombocytopenia (HIT). Although rare, this requires prompt graft removal. We present a case to highlight this serious complication and review the literature on this topic.

Heparin-PF4 Antibodies Are Frequent after Vascular Surgery, but Not a Frequent Cause of Graft Thrombosis or Thrombocytopenia.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1491-1491
Author(s):  
Tamas Alexy ◽  
Sony Tucker ◽  
Soames Boyle ◽  
Leanne Rochanda ◽  
Douglas Hood ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Graft Failure ◽  
Bypass Graft ◽  
Structural Defects ◽  
Graft Thrombosis ◽  
Blood Samples ◽  
Post Surgery ◽  
Platelet Aggregometry ◽  
Early Graft ◽  
Early Graft Failure

Abstract Surgical intervention for atherosclerotic disease of the aortoiliac and femoral-popliteal arteries has significantly reduced the incidence and complications of peripheral ischemia. However, surgical correction of obstructive arterial lesions can be complicated by either early graft failure due to acute thrombosis or late stenosis of the vascular bypass graft. Despite improvements in surgical technique, early graft failure is still observed in up to 10% of patients and up to 30 % can subsequently develop a graft stenosis. The etiology of early graft closure is less clearly understood. Anatomic or structural defects in the new graft may result in early thrombosis. Underlying prothrombotic conditions have also been suggested as contributing factors to early graft thrombosis. Recently, we have observed recurrent thrombotic events occurring in vascular grafts in two patients who were subsequently diagnosed with the syndrome of Heparin-Induced Thrombocytopenia. Because of these events we undertook an IRB approved, prospective evaluation of HIT antibodies in patients undergoing vascular surgery. Patients undergoing infra-inguinal bypass surgery for atherosclerotic vascular disease were enrolled after informed consent. Blood samples were obtained the day before surgery, day of hospital discharge, at days 14 and 28 after surgery. Platelet counts were obtained on the day of discharge and on post-surgery day 14. Plasma samples were assayed for PFA-heparin antibodies by ELISA (Stago Diagnostica) and platelet activating antibodies by platelet aggregometry. All assays were performed in duplicate. Seventy-nine patients were enrolled. Six (7.7%) patients provided only the pre-surgical blood specimen and only 68 (86%) patients provided all four blood specimens. All but 5 patients reported previous heparin exposure. Of the 73 patients in which post-surgical blood samples were taken, 28 (38%) became ELISA positive for PF4-Heparin antibodies. When tested for platelet activating antibodies, 7 (10%) were positive. All patients who developed a positive ELISA had antibody detected by day 14. Four patients tested positive by ELISA prior to surgery, with 3/4 having positive aggregation assays. One ELISA negative patient developed early graft closure. No patient developed thrombocytopenia or a 50% or greater decrease in platelet count. Patients undergoing vascular surgery frequently develop PF4-Heparin antibodies of which up to 10% patients have platelet activating antibodies. However, both thrombocytopenia and vascular graft thrombosis due to HIT is a rare event.

scholarly journals Is it better to treat bypass graft or native coronary artery following early graft failure?

2020 ◽  
Vol 36 (1) ◽  
pp. 9-11
Author(s):  
Davorin Sef ◽  
Mladen Predrijevac ◽  
Shahzad G. Raja ◽  
Marko I. Turina
Keyword(s):  
Coronary Artery ◽  
Graft Failure ◽  
Bypass Graft ◽  
Native Coronary Artery ◽  
Early Graft ◽  
Early Graft Failure

Platelet Adhesion in Polytetrafluoroethylene (PTFE) Vascular Grafts In Vivo and the Influence of Increased Intramuscular Pressure-An Experimental Model

1983 ◽  
Vol 50 (04) ◽  
pp. 881-884 ◽  
Author(s):  
J T Christenson ◽  
P Qvarfordt ◽  
S-E Strand ◽  
D Arvidsson ◽  
T Sjöberg ◽  
...  
Keyword(s):  
Blood Flow ◽  
Graft Failure ◽  
Small Diameter ◽  
Graft Material ◽  
Intramuscular Pressure ◽  
Initial Flow ◽  
Early Graft ◽  
Wick Technique ◽  
Early Graft Failure

SummaryThrombogenicity of graft material is involved in early graft failure in small diameter grafts. The frequently seen postoperative swelling of the leg after distal revascularization may cause an increased intramuscular pressure and early graft failure.Pairs of 4 mm polytetrafluoroethylene (PTFE) grafts were implanted. Autologous platelets were labeled with mIn-oxine. Platelet adhesiveness onto the grafts were analyzed from gamma camera images. Intramuscular pressures were measured with wick technique. Blood flow was measured. One graft served as control the other as test graft. Ninety minutes after declamping the i. m. pressure was increased in the test-leg to 30 mmHg, and later to 60 mmHg.In the control-graft platelet uptake increased to a maximum 60 min after declamping. Blood flow and i.m. pressure remained uneffected. The test-grafts were initially similar but when i.m. pressure was increased to 30 mmHg activity in the grafts increased significantly. Blood flow decreased with 12% of initial flow. When i. m. pressure was raised to 60 mmHg platelet uptake continued to increase.An increased intramuscular pressure of 30 mmHg or more significantly increase the amount of platelets adhering onto PTFE grafts, emphasizing the need for measuring intramuscular pressures after lower limb vascular revascularizations.

Correlation of laboratory and ECG changes with early graft failure after CABG

2005 ◽  
Vol 53 (S 01) ◽  
Author(s):  
A Schnell ◽  
A Künzli ◽  
B Seifert ◽  
O Reuthebuch ◽  
M Lachat ◽  
...  
Keyword(s):  
Graft Failure ◽  
Ecg Changes ◽  
Early Graft ◽  
Early Graft Failure

Virchow Triad, but Not Use of an Aortic Connector Device, Predicts Early Graft Failure after Off-Pump Coronary Bypass

2004 ◽  
Vol 7 (5) ◽  
pp. E428-E433 ◽  
Author(s):  
Robert Poston ◽  
Charles White ◽  
Katrina Read ◽  
Junyan Gu ◽  
Andrew Lee ◽  
...  
Keyword(s):  
Graft Failure ◽  
Coronary Bypass ◽  
Off Pump ◽  
Early Graft ◽  
Early Graft Failure ◽  
Aortic Connector

scholarly journals Prediction model for early graft failure after liver transplantation using aspartate aminotransferase, total bilirubin and coagulation factor

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jinsoo Rhu ◽  
Jong Man Kim ◽  
Kyunga Kim ◽  
Heejin Yoo ◽  
Gyu-Seong Choi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Prediction Model ◽  
Aspartate Aminotransferase ◽  
Graft Failure ◽  
Living Donor ◽  
Total Bilirubin ◽  
Deceased Donor ◽  
Time Dependent ◽  
Early Graft ◽  
Early Graft Failure

AbstractThis study was designed to build models predicting early graft failure after liver transplantation. Cox regression model for predicting early graft failure after liver transplantation using post-transplantation aspartate aminotransferase, total bilirubin, and international normalized ratio of prothrombin time was constructed based on data from both living donor (n = 1153) and deceased donor (n = 359) liver transplantation performed during 2004 to 2018. The model was compared with Model for Early Allograft Function Scoring (MEAF) and early allograft dysfunction (EAD) with their C-index and time-dependent area-under-curve (AUC). The C-index of the model for living donor (0.73, CI = 0.67–0.79) was significantly higher compared to those of both MEAF (0.69, P = 0.03) and EAD (0.66, P = 0.001) while C-index for deceased donor (0.74, CI = 0.65–0.83) was only significantly higher compared to C-index of EAD. (0.66, P = 0.002) Time-dependent AUC at 2 weeks of living donor (0.96, CI = 0.91–1.00) and deceased donor (0.98, CI = 0.96–1.00) were significantly higher compared to those of EAD. (both 0.83, P < 0.001 for living donor and deceased donor) Time-dependent AUC at 4 weeks of living donor (0.93, CI = 0.86–0.99) was significantly higher compared to those of both MEAF (0.87, P = 0.02) and EAD. (0.84, P = 0.02) Time-dependent AUC at 4 weeks of deceased donor (0.94, CI = 0.89–1.00) was significantly higher compared to both MEAF (0.82, P = 0.02) and EAD. (0.81, P < 0.001). The prediction model for early graft failure after liver transplantation showed high predictability and validity with higher predictability compared to traditional models for both living donor and deceased donor liver transplantation.

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