PMID- 33217393
OWN - NLM
STAT- MEDLINE
DCOM- 20210802
LR  - 20210802
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 112
IP  - 1
DP  - 2021 Jul
TI  - Association of Heparin Dose, Route, Timing, and Duration With Heparin-Induced 
      Thrombocytopenia.
PG  - 32-37
LID - S0003-4975(20)31922-6 [pii]
LID - 10.1016/j.athoracsur.2020.09.033 [doi]
AB  - BACKGROUND: The prevalence of heparin-induced thrombocytopenia (HIT) varies by 
      population and the type and duration of heparinoid exposure; however, the 
      association with unfractionated heparin (UFH) dose, route, timing, and duration 
      has not been evaluated in cardiac surgery patients. METHODS: A retrospective 
      case-control study matched HIT-positive adult cardiac surgery patients (positive 
      platelet factor 4 immunoglobulin G and serotonin release assays) 1:1 with 
      HIT-negative controls. Total UFH dose, route, timing, and duration were compared 
      between groups. RESULTS: The study included 124 patients, 92 male (74%), with 
      mean age of 65 +/- 11 years. Significantly more HIT-positive patients received 
      intravenous UFH preoperatively or postoperatively compared with patients without 
      HIT (55 [88.7%] vs 23 [37.1%]; P < .001). There were no significant differences 
      regarding intraoperative or subcutaneous UFH dose or duration. When controlling 
      for obesity and cardiopulmonary bypass duration using multivariable conditional 
      logistic regression, the odds of HIT were increased 10-fold in patients who 
      received preoperative or postoperative intravenous UFH continuous infusion (odds 
      ratio 10.2, 95% confidence interval, 3.1 to 33.7; P < .001). Receiver-operating 
      characteristic curves demonstrated that receiving preoperative or postoperative 
      intravenous UFH infusion total dose greater than 32,000 units (sensitivity 82%, 
      specificity 74%, area under the curve 0.78) or longer than 7 hours (sensitivity 
      87%, specificity 68%, area under the curve 0.77) was associated with HIT. 
      CONCLUSIONS: Odds of HIT were increased 10-fold in adult cardiac surgery patients 
      receiving preoperative or postoperative intravenous UFH infusion. Intraoperative 
      UFH dose and subcutaneous route were not associated with HIT. Future study should 
      evaluate incorporation of intravenous UFH administration, dose, and duration in 
      HIT scoring tools for cardiac surgery patients.
CI  - Copyright (c) 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Crow, Jessica R
AU  - Crow JR
AD  - Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland. 
      Electronic address: jcrow3@jhmi.edu.
FAU - Nam, Lucy
AU  - Nam L
AD  - Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
FAU - Chasler, Jessica E
AU  - Chasler JE
AD  - Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
FAU - Ong, Chin Siang
AU  - Ong CS
AD  - Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
FAU - Dane, Kathryn E
AU  - Dane KE
AD  - Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
FAU - Kickler, Thomas
AU  - Kickler T
AD  - Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
FAU - Lawton, Jennifer
AU  - Lawton J
AD  - Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
FAU - Streiff, Michael B
AU  - Streiff MB
AD  - Division of Hematology, Department of Medicine, The Johns Hopkins University 
      School of Medicine, Baltimore, Maryland.
FAU - Alejo, Diane
AU  - Alejo D
AD  - Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
FAU - Canner, Joseph K
AU  - Canner JK
AD  - Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
FAU - Schena, Stefano
AU  - Schena S
AD  - Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20201118
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/administration & dosage/adverse effects
MH  - *Cardiac Surgical Procedures
MH  - Case-Control Studies
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Follow-Up Studies
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Maryland/epidemiology
MH  - Middle Aged
MH  - Postoperative Complications/*prevention & control
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Thrombocytopenia/*chemically induced/epidemiology
EDAT- 2020/11/21 06:00
MHDA- 2021/08/03 06:00
CRDT- 2020/11/20 20:07
PHST- 2020/02/11 00:00 [received]
PHST- 2020/08/14 00:00 [revised]
PHST- 2020/09/09 00:00 [accepted]
PHST- 2020/11/21 06:00 [pubmed]
PHST- 2021/08/03 06:00 [medline]
PHST- 2020/11/20 20:07 [entrez]
AID - S0003-4975(20)31922-6 [pii]
AID - 10.1016/j.athoracsur.2020.09.033 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2021 Jul;112(1):32-37. doi: 10.1016/j.athoracsur.2020.09.033. 
      Epub 2020 Nov 18.