Bevilacqua Sergio, Stefàno Pierluigi, Berteotti Martina, Del Pace Stefano, Pieri Matteo, Mandarano Raffaele, Rogolino Angela, Cesari Francesca, Gori Anna Maria, Giusti Betti, Marcucci Rossella
Department of Anesthesia and Intensive Care, University Hospital Careggi, Firenze, Italy.
Department of Cardiothoracic and Vascular Surgery, University Hospital Careggi, Firenze, Italy.
Res Pract Thromb Haemost. 2024 Jun 6;8(4):102465. doi: 10.1016/j.rpth.2024.102465. eCollection 2024 May.
Cardiac surgery is a high-risk setting for heparin-induced thrombocytopenia (HIT). However, large differences in its incidence, rate of thrombotic complications, and mortality have been reported in this context. Few studies address the pharmacologic management of HIT specifically in this setting.
To describe the incidence, outcomes, and management of patients with HIT in our cohort and to compare them with patients presenting platelet factor 4/heparin antibodies but without platelet-activating capacity.
A retrospective observational study was conducted over a period of 10 years and 6 months on 13,178 cardiac operations in a single high-volume cardiac surgery center.
HIT was diagnosed in 0.22% of patients. HIT with associated thromboembolic complications occurred in 0.04% of cases. Two deaths at 30 days were registered, both in patients with associated thrombosis. The 4T score showed a 99.9% negative predictive value. The immunoglobulin G-specific chemiluminescence test positivity rate was highly predictive of HIT. Warfarin was often started early after surgery, and although it was rarely stopped when the diagnosis of HIT was made, no new thromboembolic complications subsequently occurred. Thrombocytopenia appeared to be a poor prognostic sign, whatever the cause.
Although rare, HIT is characterized by high mortality in this setting, especially if thrombotic complications occur. Large multicentric studies or an international registry should be created to enhance the scientific evidence on HIT diagnosis and management in this context.
心脏手术是肝素诱导的血小板减少症（HIT）的高风险环境。然而，关于其发病率、血栓形成并发症发生率和死亡率在这种情况下已有很大差异的报道。很少有研究专门针对这种情况下的HIT药物管理进行探讨。
描述我们队列中HIT患者的发病率、结局和管理情况，并将其与存在血小板因子4/肝素抗体但无血小板激活能力的患者进行比较。
在一个大型心脏手术中心对13178例心脏手术进行了为期10年零6个月的回顾性观察研究。
0.22%的患者被诊断为HIT。伴有血栓栓塞并发症的HIT发生率为0.04%。记录到30天内有2例死亡，均为伴有血栓形成的患者。4T评分显示阴性预测值为99.9%。免疫球蛋白G特异性化学发光试验阳性率对HIT具有高度预测性。华法林常在术后早期开始使用，虽然在诊断为HIT时很少停用，但随后未发生新的血栓栓塞并发症。无论病因如何，血小板减少似乎都是一个不良预后指标。
尽管罕见，但在这种情况下HIT的特点是死亡率高，尤其是发生血栓形成并发症时。应开展大型多中心研究或建立国际登记处，以加强关于这种情况下HIT诊断和管理的科学证据。
