Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2021 Aug;112(2):487-493. doi: 10.1016/j.athoracsur.2020.10.046. Epub 2020 Dec 9.
Heparin-induced thrombocytopenia (HIT) is an immune-mediated reaction to heparin that provokes a prothrombotic state and causes a decline in platelet count. Data describing outcomes of HIT after cardiac surgery are limited. This study sought to determine the impact of HIT on short-term outcomes after cardiac surgery.
This was an observational study of cardiac surgeries from 2010 to 2018. Patients with HIT were matched against patients without HIT using 2:1 nearest-neighbor propensity matching. Matching was performed to assess the impact of HIT on operative mortality (The Society of Thoracic Surgeons definition) and thromboembolic events (including deep vein thrombosis, pulmonary embolism, stroke, and/or acute limb ischemia), which were the primary outcomes of interest.
Of 11,820 patients undergoing a Society of Thoracic Surgeons indexed cardiac surgery, 131 (1.1%) developed HIT after their index operation. After matching operative mortality was 21.8% in HIT patients compared with 5.3% in non-HIT patients. Thromboembolic events occurred in 29.1% of HIT patients compared with 2.9% in non-HIT patients. On subanalysis operative mortality was significantly higher for the HIT group without thromboembolic events (16.7%) and the HIT group with thromboembolic events (34.4%) compared with the non-HIT group (5.3%). However operative mortality was not significantly higher in the HIT group with thromboembolic events compared with the HIT group without thromboembolic events, after Bonferroni correction.
Although uncommon, HIT is a highly morbid and potentially lethal complication, which should reinforce the importance of timely recognition and treatment of this adverse outcome.
肝素诱导的血小板减少症（HIT）是一种针对肝素的免疫介导反应，可引发血栓形成状态并导致血小板计数下降。描述心脏手术后 HIT 结局的数据有限。本研究旨在确定 HIT 对心脏手术后短期结局的影响。
这是一项 2010 年至 2018 年心脏手术的观察性研究。使用 2:1 最近邻倾向匹配法将 HIT 患者与无 HIT 患者进行匹配。进行匹配以评估 HIT 对手术死亡率（胸外科医师学会定义）和血栓栓塞事件（包括深静脉血栓形成、肺栓塞、中风和/或急性肢体缺血）的影响，这些是主要关注的结局。
在 11820 例接受胸外科医师学会索引心脏手术的患者中，有 131 例（1.1%）在其索引手术后发生 HIT。匹配后，HIT 患者的手术死亡率为 21.8%，而非 HIT 患者为 5.3%。HIT 患者发生血栓栓塞事件的比例为 29.1%，而非 HIT 患者为 2.9%。亚分析显示，无血栓栓塞事件的 HIT 组（16.7%）和有血栓栓塞事件的 HIT 组（34.4%）的手术死亡率明显高于非 HIT 组（5.3%）。然而，经过 Bonferroni 校正后，有血栓栓塞事件的 HIT 组与无血栓栓塞事件的 HIT 组之间的手术死亡率差异无统计学意义。
尽管罕见，但 HIT 是一种高度病态和潜在致命的并发症，这应加强及时识别和治疗这种不良结局的重要性。
