Abstract
A definitive diagnosis of heparin-induced thrombocytopenia (HIT) is difficult to make, especially in patients undergoing cardiac surgery. In this retrospective cohort study, we assessed the platelet count trends and the response to fondaparinux in a population of patients of suspected HIT after pulmonary endarterectomy (PEA). Patients enrolled in this study were over the age of 18 years, and survived longer than 7 days after PEA between January 1, 2011 and December 31, 2015. HIT likelihood was assessed by the 4 T’s score and interpreted by our institutional algorithm. 54 patients were operated, and 49 patients met the inclusion criteria. Six patients met the criteria for suspected HIT and were treated with fondaparinux until the platelet recovered. No significant difference was observed of clinical characteristics between intermediate to high HIT likelihood patients (HIT SUSPECTED) and low HIT likelihood patients (NO HIT SUSPECTED). HIT SUSPECTED patients reached platelet count lowest later (about 5.5 days after PEA), while NO HIT SUSPECTED patients is about 4.0 days after PEA. Percentage of platelet counts decrease (> 50%) was larger than NO HIT SUSPECTED patients (< 50%). There was no difference in mortality or residual pulmonary hypertension between HIT SUSPECTED and NO HIT SUSPECTED patients. Two HIT SUSPECTED patients who used heparin after PEA died, the other four survived by replacing heparin or low molecular weight heparin with fondaparinux. Suspected HIT patients should be surveilled carefully. Platelet counts trends may have some hints in the prevention of HIT. Fondaparinux may be effective for patients with suspected HIT.
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Funding
No part of the research presented has been funded by tobacco industry sources or other organization. This work was partially supported by the fund of National Natural Science Foundation of China (31670928). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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This study was conducted in accordance with the amended Declaration of Helsinki. The Ethics Committee of Beijing Chao-Yang Hospital of Capital Medical University approved the protocol, and written informed consents were obtained from the patients.
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Li, JF., Wu, LJ., Wen, GY. et al. Platelet count trends and response to fondaparinux in a cohort of heparin-induced thrombocytopenia suspected patients after pulmonary endarterectomy. J Thromb Thrombolysis 51, 703–710 (2021). https://doi.org/10.1007/s11239-020-02260-y
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DOI: https://doi.org/10.1007/s11239-020-02260-y