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Difficult Decisions in Cardiothoracic Critical Care Surgery pp 455–479Cite as

If the Platelets Are Low, Is It HIT?

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Intraoperative heparin exposure and intra-/postoperative thrombocytopenia occur universally with cardiac surgery. Sometimes, heparin triggers formation of highly pathological platelet-activating antibodies that cause thrombocytopenia, hypercoagulability, and greatly increased risk of venous and/or arterial thrombosis beginning approximately 1 week post-surgery, a disorder called heparin-induced thrombocytopenia (HIT). The challenge is to distinguish HIT from the myriad of non-HIT thrombocytopenic disorders common to this patient population. The characteristic timing of HIT, and its hallmark of associated thrombosis, means that any otherwise unexplained platelet count fall of >40% (especially with associated thrombotic event) that begins during the characteristic day 5–10 “window” post-cardiac surgery should be presumed to be HIT unless proven otherwise. In contrast, early-onset and persisting thrombocytopenia following cardiac surgery is unlikely to be HIT. Growing recognition that HIT can begin or worsen after all heparin has been stopped (“autoimmune HIT”) indicates that this diagnosis should be considered even when thrombocytopenia or thrombosis is recognized up to 1 month following cardiac surgery.

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Notes

  1. 1.

    Search details: Heparin-induced[All Fields] AND (“thrombocytopaenia”[All Fields] OR “thrombocytopenia”[MeSH Terms] OR “thrombocytopenia”[All Fields]) AND (“thoracic surgery”[MeSH Terms] OR (“thoracic”[All Fields] AND “surgery”[All Fields]) OR “thoracic surgery”[All Fields] OR (“cardiac”[All Fields] AND “surgery”[All Fields]) OR “cardiac surgery”[All Fields] OR “cardiac surgical procedures”[MeSH Terms] OR (“cardiac”[All Fields] AND “surgical”[All Fields] AND “procedures”[All Fields]) OR “cardiac surgical procedures”[All Fields] OR (“cardiac”[All Fields] AND “surgery”[All Fields])).

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Authors and Affiliations

  1. Department of Pathology and Molecular Medicine, and Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Theodore E. Warkentin

  2. Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton General Hospital, Hamilton, ON, Canada

    Theodore E. Warkentin

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  1. Theodore E. Warkentin
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Correspondence to Theodore E. Warkentin .

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Editors and Affiliations

  1. University of Chicago Medicine, Chicago, IL, USA

    Vassyl A. Lonchyna

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Warkentin, T.E. (2019). If the Platelets Are Low, Is It HIT?. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_32

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  • DOI: https://doi.org/10.1007/978-3-030-04146-5_32

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