Abstract
PurposeThe present study aimed to explore the clinical characteristics of heparin-induced thrombocytopenia (HIT) after surgery for acute type A aortic dissection and perform a relevant prognostic analysis.MethodsAfter continuous observation and analysis of 204 patients who underwent acute type A aortic dissection, we found that blood platelets decreased significantly after surgery and that these patients can be suspected to suffer HIT based on relevant 4Ts scores. For these suspected HIT patients, a latex particle-enhanced immunoturbidimetric assay was conducted to detect heparin-induced antibodies. Perioperative clinical data of patients in HIT and non-HIT groups were recorded as were blood platelet counts, HIT antibody test results, 4Ts scores, thromboembolic complications, clinical prognosis and outcomes.ResultsIn the present study, 38 suspected HIT patients, 16 HIT patients and 188 non-HIT patients were selected in the clinical setting. Among them, HIT patients were found to have prolonged cardiopulmonary bypass time (223 min on average vs. 164 min) and delayed aortic cross-clamp time (128 min on average vs. 107 min), and these differences between HIT patients and non-HIT patients were significant (P < 0.05). Additionally, the HIT group required longer operation time and higher dose of heparin, but showing no statistical differences (P > 0.05). The transfusions of blood platelets in the HIT group and non-HIT group were 18.7 ± 5.0u and 15.6 ± 7.34 u, respectively. In the HIT group, the mechanic ventilation time and the length of ICU stay were longer comparing the non-HIT group(P < 0.05), though no significant differences in total length of stay or In-hospital mortality were observed (P > 0.05). The incidence of continuous renal replacement therapy in HIT group was higher than the non-HIT group (P < 0.05). Additionally,there were no significant differences in 24-h postoperative drainage or reoperation for bleeding in both group(P > 0.05). However, the HIT antibody titer in the HIT group was significantly higher than that in the Suspected HIT group (2.7 ± 0.8 U/mL vs. 0.3 ± 0.2 U/mL) (P < 0.05). Among patients diagnosed with HIT, the incidence of thromboembolism reached 31.5%.For example, two HIT patients newly developed thromboembolism in both lower extremities,and three patients experienced cerebral infarction.ConclusionsAfter surgery for acute type A aortic dissection, HIT patients developed postoperative complications, the duration of ventilatory support and length of ICU stay were extended, and the incidence of thromboembolism increased. HIT antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics.
Highlights
IntroductionHeparin-induced thrombocytopenia (HIT) is an iatrogenic disease that potentially threatens the lives of people exposed to heparin or low-molecular-weight heparin
Heparin-induced thrombocytopenia (HIT) antibody detection and risk classification should be implemented for high-risk patients showing early clinical characteristics
Heparin-induced thrombocytopenia (HIT) is an iatrogenic disease that potentially threatens the lives of people exposed to heparin or low-molecular-weight heparin
Summary
Heparin-induced thrombocytopenia (HIT) is an iatrogenic disease that potentially threatens the lives of people exposed to heparin or low-molecular-weight heparin. A reduction in blood platelet count (PLTc) after surgery for acute type A aortic dissection (ATAAD) commonly occurs in the clinical setting. No specificity in clinical manifestations of HIT has been found, which mainly include PLTc decrease at several days or months after heparin therapy along with the presence or absence of a newly developed thromboembolism. In this case, a contradictory state between a decrease in PLTc and thrombosis occurs. Patients undergoing acute type A aortic dissection were observed for signs of HIT, and clinical outcomes after surgery were assessed. Appropriate support can be provided for clinical prevention and prognosis
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