Guimbretière Guillaume, Dubost Clément, Issard Justin, Louvain-Quintard Virginie, Jais Xavier, Dolidon Samuel, Stephan François, Ion Daniela-Iolanda, Mercier Olaf, Fadel Elie
Department of Thoracic Surgery and Heart-Lung Transplantation, Paris-Saclay University, Marie-Lannelongue Hospital, Le Plessis-Robinson, France.
Department of Biology and Hemostasis, Marie Lannelongue Hospital, Le Plessis-Robinson, France.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 25;40(1). doi: 10.1093/icvts/ivaf001.
Heparin is given for anticoagulation during and after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Our objective was to add to the limited data available on the incidence, management and outcomes of suspected heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.
This retrospective single-centre study included consecutive patients with suspected heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy done in 2005-2018. Confirmed heparin-induced thrombocytopaenia was defined as positive findings from both the antibody test and the platelet aggregation test. Patients with versus without confirmed heparin-induced thrombocytopaenia were compared, as well as patients with versus without heparin replacement therapy within the group with unconfirmed heparin-induced thrombocytopaenia. The platelet counts over time were compared to those in controls without suspected heparin-induced thrombocytopaenia.
Heparin-induced thrombocytopaenia was suspected in 86 (6.3%) of 1360 patients and confirmed in 16 (16/86, 19%), all of whom received heparin replacement therapy and survived to intensive care unit discharge. Of the remaining 70 patients, 28 (40%) received heparin replacement therapy and less often experienced bleeding compared to the other 42 (3.6% vs 21.4%, P = 0.043). Intensive care unit mortality was 17/70 (24.3%) and was lower in the subgroup given heparin replacement therapy (10.7% vs 33.3%; P = 0.046). Confirmed heparin-induced thrombocytopaenia was associated with a sharp platelet-count drop on Day 5. In unconfirmed suspected heparin-induced thrombocytopaenia, the early platelet-count decline was similar to that in the controls without suspected heparin-induced thrombocytopaenia, but the baseline count was lower.
Clinical features suggesting heparin-induced thrombocytopaenia after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension were associated with excess mortality. Relay heparin replacement therapy was associated with lower mortality and fewer bleeding events.
在慢性血栓栓塞性肺动脉高压的肺动脉血栓内膜剥脱术期间及术后给予肝素进行抗凝治疗。我们的目的是补充关于慢性血栓栓塞性肺动脉高压患者在肺动脉血栓内膜剥脱术后疑似肝素诱导的血小板减少症的发生率、管理及结局的有限数据。
这项回顾性单中心研究纳入了2005年至2018年期间在肺动脉血栓内膜剥脱术后疑似肝素诱导的血小板减少症的连续患者。确诊的肝素诱导的血小板减少症定义为抗体检测和血小板聚集试验均呈阳性结果。比较确诊与未确诊肝素诱导的血小板减少症的患者，以及在未确诊肝素诱导的血小板减少症组中接受与未接受肝素替代治疗的患者。将随时间变化的血小板计数与无疑似肝素诱导的血小板减少症的对照组进行比较。
1360例患者中有86例（6.3%）疑似肝素诱导的血小板减少症，其中16例确诊（16/86，19%），所有确诊患者均接受了肝素替代治疗并存活至重症监护病房出院。其余70例患者中，28例（40%）接受了肝素替代治疗，与其他42例相比，出血发生率较低（3.6%对21.4%，P = 0.043）。重症监护病房死亡率为17/70（24.3%），在接受肝素替代治疗的亚组中较低（10.7%对33.3%；P = 0.046）。确诊的肝素诱导的血小板减少症与第5天血小板计数急剧下降有关。在未确诊的疑似肝素诱导的血小板减少症中，早期血小板计数下降与无疑似肝素诱导的血小板减少症的对照组相似，但基线计数较低。
慢性血栓栓塞性肺动脉高压患者在肺动脉血栓内膜剥脱术后提示肝素诱导的血小板减少症的临床特征与死亡率增加有关。继续进行肝素替代治疗与较低的死亡率和较少的出血事件相关。
