gms | German Medical Science

128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

Impact of heparin-induced thrombocytopenia (HIT) on outcome after cardiac surgery

Meeting Abstract

  • Udo Boeken - Uniklinik Düsseldorf, Kardiovaskuläre Chirurgie, Düsseldorf
  • Alexander Assmann - Uniklinik Düsseldorf, Kardiovaskuläre Chirurgie, Düsseldorf
  • Payam Akhyari - Uniklinik Düsseldorf, Kardiovaskuläre Chirurgie, Düsseldorf
  • Artur Lichtenberg - Uniklinik Düsseldorf, Kardiovaskuläre Chirurgie, Düsseldorf

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch686

DOI: 10.3205/11dgch686, URN: urn:nbn:de:0183-11dgch6862

Veröffentlicht: 20. Mai 2011

© 2011 Boeken et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Introduction: In cardiac surgery patients face an approximate 1% to 2% risk of developping HIT. We wanted to analyse the impact of HIT on postoperative course and to identify risk factors correlating with the incidence of HIT.

Materials and methods: Between 2004 and 2009 553 out of all cardiac surgery patients suffered from postoperative thrombocytopenia, defined as at least 50% drop in platelet count or absolute count <80.000 ml. These patients underwent at least one ELISA for HIT platelet factor 4 antibodies. Perioperative risk factors, morbidity and mortality of patients with a positive HIT assay (HIT+) were compared to patients without HIT antibodies (HIT-) despite thrombocytopenia and to patients without thrombocytopenia (controls).

Results: 28% of all patients with postoperative thrombocytopenia were HIT+ (155 of 553). After multivariate regression analysis we found perioperative predictors of HIT: preoperative renal failure, previous coronary interventions (<4 weeks), emergent procedures, prolonged duration of ECC and of crossclamping and postoperative LCOS. Postoperatively, prolonged mechanical ventilation and ICU-stay (4.3±1.2 vs. 1.9±0.5 days, p<0.05) could be detected in HIT+ patients compared to controls. These HIT+ patients suffered more often from infectious complications compared to HIT- (32.3% vs. 15.6, p<0.05) and they had a higher rate of postoperative renal failure requiring hemodialysis (23.2% vs. 7.8%, p<0.05) and of thromboembolic complications. In-hospital-mortality was significantly higher in the HIT+ group (19.4% vs. 9.0%, p<0.05).

Conclusion: In cardiac surgery, HIT is a rare but serious complication. HIT patients face a significant increased risk of postoperative morbidity and mortality. With regard to perioperative risk factors, early detection of HIT antibodies with immediate application of an alternative anticoagulation therapy might be a strategy to improve outcome.