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Arangalage D, Lepage L, Faille D, Cimadevilla C, Dilly MP, Papy E, Alhenc-Gelas M, Ghodbane W, Nataf P, Iung B, Steg PG, Vahanian A, Ajzenberg N, Messika-Zeitoun D. Presentation, management and outcome of heparin-induced thrombocytopenia after valvular heart surgery. Eur J Cardiothorac Surg 2016; 50:1132-1138. [PMID: 27301386 DOI: 10.1093/ejcts/ezw200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 12/13/2022] Open
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.
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Affiliation(s)
- Dimitri Arangalage
- Department of Cardiology, Bichat Hospital, Paris, France.,INSERM U1148, Bichat Hospital, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France
| | - Laurent Lepage
- Department of Cardiac Surgery, Bichat Hospital, Paris, France
| | - Dorothée Faille
- INSERM U1148, Bichat Hospital, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.,Department of Hematology, Bichat Hospital, Paris, France
| | | | | | | | - Martine Alhenc-Gelas
- Department of Biological Hematology, European Hospital Georges Pompidou, AP-HP, Paris, France
| | - Walid Ghodbane
- Department of Cardiac Surgery, Bichat Hospital, Paris, France
| | - Patrick Nataf
- INSERM U1148, Bichat Hospital, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, Paris, France.,INSERM U1148, Bichat Hospital, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France
| | - Philippe Gabriel Steg
- Department of Cardiology, Bichat Hospital, Paris, France.,INSERM U1148, Bichat Hospital, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat Hospital, Paris, France.,INSERM U1148, Bichat Hospital, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France
| | - Nadine Ajzenberg
- INSERM U1148, Bichat Hospital, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France.,Department of Hematology, Bichat Hospital, Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, Bichat Hospital, Paris, France .,INSERM U1148, Bichat Hospital, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine Paris-Diderot, Paris, France
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