Kuitunen Anne, Suojaranta-Ylinen Raili, Raivio Peter, Kukkonen Sinikka, Lassila Riitta
Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
J Cardiothorac Vasc Anesth. 2007 Feb;21(1):18-22. doi: 10.1053/j.jvca.2006.05.002. Epub 2006 Aug 23.
The outcome of cardiac surgical patients with clinically diagnosed heparin-induced thrombocytopenia (HIT) was studied.
Retrospective, observational study.
University hospital.
All cardiac surgical patients with diagnosed HIT after cardiac surgery between January 2002 and December 2004, and concurrently, consecutive patients without HIT.
None Measurements and Main Results: 3465 patients were treated postoperatively in the cardiac surgical intensive care unit during the study period. Clinical suspicion of HIT arose when platelet count markedly fell several days after surgery and HIT was proven by a positive enzyme immunoassay in 20 patients. Thrombocytopenia (35.5 [22] x 10(9)/L, median [interquartile range]) developed within 7 (6) days. HIT patients received significantly more platelet transfusions perioperatively than controls (p < 0.001). Thromboembolic complications occurred in 70% of HIT patients, but in none of non-HIT patients (14/20 v 0/20, p = 0.001). Intensive care unit stay was longer in HIT patients than in controls (16.5 [11.0] v 1.0 [3.0] days, p < 0.001). Nine HIT patients died (45%), while all control patients survived. Mortality was related to thrombotic complications in seven HIT patients (35%).
The incidence of HIT in association with low-molecular-weight heparin use after cardiac surgery was low. HIT was associated with perioperative platelet transfusions and carried a remarkably high risk of thromboembolic complications and death. In order to reduce morbidity and mortality, early recognition of heparin-associated antiplatelet antibodies and alternative anticoagulation strategies need to be implemented.
研究临床诊断为肝素诱导的血小板减少症（HIT）的心脏手术患者的预后。
回顾性观察研究。
大学医院。
2002年1月至2004年12月期间心脏手术后诊断为HIT的所有心脏手术患者，以及同期连续的无HIT患者。
无 测量指标和主要结果：研究期间，3465例患者在心脏外科重症监护病房接受术后治疗。术后数天血小板计数明显下降时出现HIT临床疑似病例，20例患者酶免疫测定呈阳性，证实为HIT。血小板减少症（35.5 [22]×10⁹/L，中位数[四分位间距]）在7（6）天内出现。HIT患者围手术期接受血小板输注的次数明显多于对照组（p<0.001）。70%的HIT患者发生血栓栓塞并发症，而非HIT患者均未发生（14/20对0/20，p = 0.001）。HIT患者在重症监护病房的住院时间比对照组更长（16.5 [11.0]天对1.0 [3.0]天，p<0.001）。9例HIT患者死亡（45%），而所有对照患者均存活。7例HIT患者（35%）的死亡与血栓形成并发症有关。
心脏手术后使用低分子量肝素相关的HIT发生率较低。HIT与围手术期血小板输注有关，血栓栓塞并发症和死亡风险极高。为降低发病率和死亡率，需要尽早识别肝素相关的抗血小板抗体并实施替代抗凝策略。
