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Platelet count trends and response to fondaparinux in a cohort of heparin-induced thrombocytopenia suspected patients after pulmonary endarterectomy.

Authors
  • Li, Ji-Feng1, 2, 3, 4
  • Wu, Li-Juan5, 6
  • Wen, Ge-Yi4
  • Zhou, Rong-Rong4
  • Liu, Fang7
  • Wang, Wei4
  • Yang, Su-Qiao1, 2, 3, 4
  • Gong, Juan-Ni1, 2, 3, 4
  • Miao, Ran2, 3, 4
  • Gu, Song8
  • Liu, Yan9
  • Yang, Yuan-Hua10, 11, 12, 13
  • 1 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China. , (China)
  • 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China. , (China)
  • 3 Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China. , (China)
  • 4 Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China. , (China)
  • 5 School of Public Health, Capital Medical University, 100020, Beijing, P.R. China. , (China)
  • 6 Beijing Key Laboratory of Epidemilology, Capital Medical University, 100020, Beijing, P.R. China. , (China)
  • 7 Department of Respiratory Medicine, The Branch of Tangshan Gongren Hospital, 063000, Tangshan, P.R. China. , (China)
  • 8 Department of Cardiac Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China. , (China)
  • 9 Department of Cardiac Surgery, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China. [email protected] , (China)
  • 10 Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China. [email protected] , (China)
  • 11 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China. [email protected] , (China)
  • 12 Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, P.R. China. [email protected] , (China)
  • 13 Department of Respiratory Disease, Capital Medical University, 100069, Beijing, P.R. China. [email protected] , (China)
Type
Published Article
Journal
Journal of Thrombosis and Thrombolysis
Publisher
Springer-Verlag
Publication Date
Sep 07, 2020
Identifiers
DOI: 10.1007/s11239-020-02260-y
PMID: 32894400
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

A definitive diagnosis of heparin-induced thrombocytopenia (HIT) is difficult to make, especially in patients undergoing cardiac surgery. In this retrospective cohort study, we assessed the platelet count trends and the response to fondaparinux in a population of patients of suspected HIT after pulmonary endarterectomy (PEA). Patients enrolled in this study were over the age of 18 years, and survived longer than 7 days after PEA between January 1, 2011 and December 31, 2015. HIT likelihood was assessed by the 4 T's score and interpreted by our institutional algorithm. 54 patients were operated, and 49 patients met the inclusion criteria. Six patients met the criteria for suspected HIT and were treated with fondaparinux until the platelet recovered. No significant difference was observed of clinical characteristics between intermediate to high HIT likelihood patients (HIT SUSPECTED) and low HIT likelihood patients (NO HIT SUSPECTED). HIT SUSPECTED patients reached platelet count lowest later (about 5.5 days after PEA), while NO HIT SUSPECTED patients is about 4.0 days after PEA. Percentage of platelet counts decrease (> 50%) was larger than NO HIT SUSPECTED patients (< 50%). There was no difference in mortality or residual pulmonary hypertension between HIT SUSPECTED and NO HIT SUSPECTED patients. Two HIT SUSPECTED patients who used heparin after PEA died, the other four survived by replacing heparin or low molecular weight heparin with fondaparinux. Suspected HIT patients should be surveilled carefully. Platelet counts trends may have some hints in the prevention of HIT. Fondaparinux may be effective for patients with suspected HIT.

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