Research on Clinical Characteristics and Prognostic Analysis of Heparin-Induced Thrombocytopenia After Surgery for Acute Type a Aortic Dissection

Abstract PurposeThe present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis. MethodsAfter continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes. ResultsIn the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time(223min on average vs. 164min) and delayed aortic cross-clamp time(128min on average vs. 107min), and these differences between HIT patients and non-HIT patients were significant (P<0.05). Additionally, the HIT group required longer operation time and higher dose of heparin, but showing no statistical differences(P>0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7±5.0u and 15.6±7.34 u, respectively.In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P<0.05), though no significant differences in total length of stay or In-hospital mortality were observed (P>0.05).The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group(P<0.05). Additionally,there were no significant differences in 24-h postoperative drainage or reoperation for bleeding in both group(P>0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group(2.7±1.8U/mL vs. 0.3±0.2U/mL)(P<0.05).Among patients diagnosed with HIT, the incidence of thromboembolism reached 31.5%.For example, two HIT patients newly developed thromboembolism in both lower extremities,and three patients experienced cerebral infarction. ConclusionsAfter surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.

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Research on clinical characteristics and prognostic analysis of heparin-induced thrombocytopenia after surgery for acute type a aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01482-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chu-zhi Zhou ◽

Dong-jie Feng ◽

Yuan Fang ◽

Feng-yan Zha ◽

Er-hui Wang ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Characteristics ◽

Blood Platelets ◽

Type A ◽

Acute Type ◽

Heparin Induced Thrombocytopenia ◽

Type A Aortic Dissection ◽

Icu Stay ◽

Prognostic Analysis ◽

Length Of Icu Stay

Abstract Purpose The present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis. Methods After continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes. Results In the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time (223 min on average vs. 164 min) and delayed aortic cross-clamp time (128 min on average vs. 107 min), and these differences between HIT patients and non-HIT patients were significant (P < 0.05). Additionally, the HIT group required longer operation time and higher dose of heparin, but showing no statistical differences (P > 0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7 ± 5.0u and 15.6 ± 7.34 u, respectively. In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P < 0.05), though no significant differences in total length of stay or In-hospital mortality were observed (P > 0.05). The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group (P < 0.05). Additionally,there were no significant differences in 24-h postoperative drainage or reoperation for bleeding in both group(P > 0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group (2.7 ± 0.8 U/mL vs. 0.3 ± 0.2 U/mL) (P < 0.05). Among patients diagnosed with HIT, the incidence of thromboembolism reached 31.5%.For example, two HIT patients newly developed thromboembolism in both lower extremities,and three patients experienced cerebral infarction. Conclusions After surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.

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Association of NFE2L2 Gene Polymorphisms with Risk and Clinical Characteristics of Acute Type A Aortic Dissection in Han Chinese Population

Oxidative Medicine and Cellular Longevity ◽

10.1155/2021/5173190 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Yiran Zhang ◽

Qi Zheng ◽

Ruoshi Chen ◽

Xiaoyi Dai ◽

Yimin Zhu ◽

...

Keyword(s):

Aortic Dissection ◽

Gene Polymorphisms ◽

Chinese Population ◽

Clinical Characteristics ◽

Type A ◽

Han Chinese ◽

Control Group ◽

Acute Type ◽

Type A Aortic Dissection ◽

Han Chinese Population

The present study is aimed at investigating the association of NFE2L2 gene polymorphisms with risk and clinical characteristics of acute type A aortic dissection (AAAD) in a Han Chinese population. Six SNPs (rs1806649, rs13001694, rs2364723, rs35652124, rs6721961, and rs2706110) in NFE2L2 were genotyped using SNaPshot Multiplex Kit in 94 adult patients diagnosed with AAAD at our hospital, and 208 healthy Han Chinese subjects from the 1000 Genomes Project were served as the control group. The CC genotype of rs2364723 (CC versus (GC+GG), OR = 2.069 , 95% CI: 1.222-3.502, p = 0.006 ) and CC genotype of rs35652124 (CC versus (CT+TT), OR = 1.889 , 95% CI: 1.112-3.210, p = 0.018 ) were identified as risk factors for AAAD. Multivariable linear regression analysis revealed that the CC genotype of rs2364723 ( β = 5.031 , 95% CI: 1.878-8.183, p = 0.002 ) and CC genotype of rs35652124 ( β = 4.751 , 95% CI: 1.544-7.958, p = 0.004 ) were associated with increased maximum ascending aorta diameter of AAAD. Patients carrying rs2364723 CC genotype had a higher incidence of coronary artery involvement (31% vs. 12%, p = 0.027 ), while patients carrying rs35652124 CC genotype had a higher incidence of brain ischemia (9% vs. 0%, p = 0.045 ). In conclusion, NFE2L2 gene polymorphisms were correlated with risk and severity of AAAD in Han Chinese population.

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