PMID- 35869817
OWN - NLM
STAT- MEDLINE
DCOM- 20221025
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7933 (Print)
IS  - 1538-7836 (Linking)
VI  - 20
IP  - 11
DP  - 2022 Nov
TI  - Temporal presentations of heparin-induced thrombocytopenia following cardiac 
      surgery: A single-center, retrospective cohort study.
PG  - 2601-2616
LID - 10.1111/jth.15826 [doi]
AB  - BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an important adverse drug 
      reaction that can occur postcardiac surgery. Preoperative exposure to 
      unfractionated heparin (UFH) is common, raising the issue of how frequently 
      cardiac surgery-associated HIT occurs after immunizing preoperative exposure to 
      heparin. OBJECTIVE: To determine the frequency and clinical picture of HIT 
      occurring within 4 days of cardiac surgery (early presentation) versus later 
      presentations (typical, delayed). METHODS: We identified patients with 
      laboratory-confirmed HIT following cardiac surgery over 30 years in a single 
      cardiac surgery center. Three different clinical presentations of HIT were 
      identified: typical (HIT-related platelet count fall beginning between 
      postoperative days [PODs] 5-10), delayed (patients with falls after POD10 or who 
      presented following hospital discharge), and early (established before POD5, 
      including during cardiac surgery [acute intraoperative HIT]). RESULTS: Of 129 
      patients identified with HIT complicating cardiac surgery, 100 had typical and 16 
      had delayed presentation of HIT; only 13 patients (10.1%) presented with early 
      HIT, all of whom had received exposure to UFH during the 10 days before cardiac 
      surgery. No patient was identified in whom remote preoperative UFH exposure was 
      implicated in explaining early HIT. Notably, five patients appeared to have had 
      acute intraoperative HIT, without immediate adverse consequences. CONCLUSIONS: 
      Approximately 90% of patients with HIT after cardiac surgery appear to develop 
      this complication due to immunization triggered by cardiac surgery; however, in 
      approximately 10% of patients, early presentation during the first four PODs (or 
      intraoperatively) can be explained by recent immunizing exposure to heparin.
CI  - (c) 2022 The Authors. Journal of Thrombosis and Haemostasis published by Wiley 
      Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.
FAU - Warkentin, Theodore E
AU  - Warkentin TE
AUID- ORCID: 0000-0002-8046-7588
AD  - Department of Pathology and Molecular Medicine, McMaster University, Hamilton, 
      Ontario, Canada.
AD  - Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
AD  - Transfusion Medicine, Hamilton Regional Laboratory Medicine Program, Hamilton, 
      Ontario, Canada.
AD  - Service of Benign Hematology, Hamilton Health Sciences, Hamilton, Ontario, 
      Canada.
FAU - Sheppard, Jo-Ann I
AU  - Sheppard JI
AUID- ORCID: 0000-0002-4402-7809
AD  - Department of Pathology and Molecular Medicine, McMaster University, Hamilton, 
      Ontario, Canada.
FAU - Whitlock, Richard P
AU  - Whitlock RP
AUID- ORCID: 0000-0002-6863-5884
AD  - Department of Surgery, Division of Cardiac Surgery, McMaster University, 
      Hamilton, Ontario, Canada.
LA  - eng
PT  - Journal Article
DEP - 20220811
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
SB  - IM
CIN - J Thromb Haemost. 2022 Nov;20(11):2491-2493. PMID: 36271465
MH  - Humans
MH  - Heparin/adverse effects
MH  - Retrospective Studies
MH  - Anticoagulants/adverse effects
MH  - *Thrombocytopenia/chemically induced/diagnosis/complications
MH  - *Cardiac Surgical Procedures/adverse effects
PMC - PMC9805231
OTO - NOTNLM
OT  - cardiopulmonary bypass
OT  - heparin
OT  - platelet count
OT  - thrombocytopenia
OT  - thrombosis
COIS- T.E.W. has received lecture honoraria from Alexion and Instrumentation 
      Laboratory, and royalties from Informa (Taylor & Francis); has provided 
      consulting services to Aspen Canada, Aspen Global, CSL Behring, Ergomed, Paradigm 
      Pharmaceuticals, and Octapharma; has received research funding from 
      Instrumentation Laboratory; and has provided expert witness testimony relating to 
      heparin-induced thrombocytopenia (HIT) and non-HIT thrombocytopenic and 
      coagulopathic disorders. J.I.S.: None. R.P.W.: None.
EDAT- 2022/07/24 06:00
MHDA- 2022/10/26 06:00
PMCR- 2022/12/31
CRDT- 2022/07/23 05:03
PHST- 2022/07/05 00:00 [revised]
PHST- 2022/05/09 00:00 [received]
PHST- 2022/07/18 00:00 [accepted]
PHST- 2022/07/24 06:00 [pubmed]
PHST- 2022/10/26 06:00 [medline]
PHST- 2022/07/23 05:03 [entrez]
PHST- 2022/12/31 00:00 [pmc-release]
AID - S1538-7836(22)18465-5 [pii]
AID - JTH15826 [pii]
AID - 10.1111/jth.15826 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2022 Nov;20(11):2601-2616. doi: 10.1111/jth.15826. Epub 2022 
      Aug 11.