Rodriguez Emily, Daskam Maria, Shou Benjamin L, Woodrum Charles, Gupta Ria, Dane Kathryn E, Alejo Diane, Sussman Marc, Schena Stefano
Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Linguistics, The Ohio State University, Columbus, Ohio.
JTCVS Open. 2024 Nov 10;23:190-198. doi: 10.1016/j.xjon.2024.10.029. eCollection 2025 Feb.
Heparin-induced thrombocytopenia (HIT) after cardiac surgery may lead to greater morbidity and mortality than predicted preoperatively. The aim of this study is to assess long-term outcomes of patients surviving HIT after cardiac surgery.
Single-institution, retrospective study of adult patients who underwent cardiac surgery between 2011 and 2023 and developed HIT postoperatively. The institutional Society of Thoracic Surgeons database and electronic medical record were integrated with longitudinal data from phone questionnaires. HIT was defined by combined clinical (4Ts score) and serologic manifestations: a platelet decrease >50% from preoperative baseline, a high optical density positive heparin-PF4 antibody test, and a positive serotonin release assay.
We identified 88 of 11,658 patients (0.8%) with HIT after cardiac surgery. The majority were male (74%), white (73.8%), and with a mean age of 65.6 ± 11.6 years. Seventy-seven (87.5%) survived to discharge, had a 4Ts score of 5 [4-6], and 58 (75.3%) were discharged on oral anticoagulation, with only 22 (28.6%) receiving treatment for the past 3 months, for a median of 1.3 [0.8-4.5] years. Median length of stay was 24 [17-35] days and length of follow-up was 4.6 [0.3-12] years. Readmission occurred in 70.1% (n = 54) of patients, with an average of 3 [1-6] readmissions/patient. Causes of death during follow-up included cardiac (n = 7, 24.1%), infectious (n = 6, 20.7%), or neurologic events (n = 5, 17.3). Ten-year survival probability was 48%.
Patients who develop HIT after cardiac surgery have an overall poor prognosis even after hospital discharge. In addition to prolonged hospitalization, patients experience further complications leading to frequent early readmissions and elevated mortality in the long-term.
心脏手术后发生肝素诱导的血小板减少症（HIT）可能导致比术前预测更高的发病率和死亡率。本研究的目的是评估心脏手术后HIT存活患者的长期预后。
对2011年至2023年间接受心脏手术并术后发生HIT的成年患者进行单机构回顾性研究。将机构胸外科医师协会数据库和电子病历与电话调查问卷的纵向数据相结合。HIT通过临床（4Ts评分）和血清学表现综合定义：血小板计数较术前基线下降>50%、肝素-PF₄抗体检测光密度高阳性以及5-羟色胺释放试验阳性。
我们在11658例心脏手术患者中识别出88例（0.8%）发生HIT。大多数为男性（74%）、白人（73.8%），平均年龄65.6±11.6岁。77例（87.5%）存活至出院，4Ts评分为5[4-6]，58例（75.3%）出院时接受口服抗凝治疗，过去3个月仅有22例（28.6%）接受治疗，中位治疗时间为1.3[0.8-4.5]年。中位住院时间为24[17-35]天，随访时间为4.6[0.3-12]年。70.1%（n=54）的患者再次入院，平均每位患者再次入院3[1-6]次。随访期间的死亡原因包括心脏相关（n=7，24.1%）、感染性（n=6，20.7%）或神经系统事件（n=5，17.3%）。10年生存概率为48%。
心脏手术后发生HIT的患者即使出院后总体预后也较差。除了住院时间延长外，患者还会出现进一步的并发症，导致频繁早期再次入院和长期死亡率升高。
