Patency of coronary artery bypass grafts in patients with heparin-induced thrombocytopenia

Abstract

Heparin is administered to virtually all patients undergoing cardiopulmonary bypass. The complications of heparin include heparin-induced thrombocytopenia (HIT), which occurs in approximately 1% of patients undergoing coronary artery bypass grafting (CABG). 1 Singer R.L. Mannion J.D. Bauer T.L. Armenti F.R. Edie R.N. Complications from heparin-induced thrombocytopenia in patients undergoing cardiopulmonary bypass. Chest. 1993; 104: 1436-1440 Crossref PubMed Scopus (104) Google Scholar , 2 Walls J.T. Curtis J.J. Silver D. Boley T.M. Schmaltz R.A. Nawarawong W. Heparin-induced thrombocytopenia in open heart surgical patients sequelae of late recognition. Ann Thorac Surg. 1992; 53: 787-791 Abstract Full Text PDF PubMed Scopus (100) Google Scholar Current evidence suggests that HIT is mediated by antibodies that react with heparin and platelet factor 4. The heparin, platelet factor 4, and antibodies form immune complexes, which activate platelets and the coagulation cascade, resulting in a hypercoagulable state. 3 Chong B.H. Heparin-induced thrombocytopenia. Br J Haematol. 1995; 89: 431-439 Crossref PubMed Scopus (254) Google Scholar This can result in the development of arterial and venous thrombosis at multiple sites. 1 Singer R.L. Mannion J.D. Bauer T.L. Armenti F.R. Edie R.N. Complications from heparin-induced thrombocytopenia in patients undergoing cardiopulmonary bypass. Chest. 1993; 104: 1436-1440 Crossref PubMed Scopus (104) Google Scholar , 2 Walls J.T. Curtis J.J. Silver D. Boley T.M. Schmaltz R.A. Nawarawong W. Heparin-induced thrombocytopenia in open heart surgical patients sequelae of late recognition. Ann Thorac Surg. 1992; 53: 787-791 Abstract Full Text PDF PubMed Scopus (100) Google Scholar , 3 Chong B.H. Heparin-induced thrombocytopenia. Br J Haematol. 1995; 89: 431-439 Crossref PubMed Scopus (254) Google Scholar The reported incidence of venous and arterial thrombosis in HIT ranges from 39% to 53%. 4 Warkentin T.E. Heparin-induced thrombocytopenia a ten-year retrospective. Annu Rev Med. 1999; 50: 129-147 Crossref PubMed Scopus (121) Google Scholar , 5 Wallis D.E. Workman D.L. Lewis B.E. Steen L. Pifarre R. Moran J.F. Failure of early heparin cessation as treatment for heparin-induced thrombocytopenia. Am J Med. 1999; 106: 629-635 Abstract Full Text Full Text PDF PubMed Scopus (315) Google Scholar Internal mammary and saphenous vein (SV) graft occlusion rates in the setting of HIT are unknown. In this study, the graft patency of post-CABG patients with HIT was assessed and compared with graft patency of non-HIT post-CABG patients.