Heparin-induced thrombocytopenia (HIT) in pediatric cardiac surgery: An emerging cause of morbidity and mortality

Bahaaldin Alsoufi, Lynn Boshkov, Aileen Kirby, Laura Ibsen, Nancy Dower, Irving Shen, Ross Ungerleider

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Unfractionated heparin (UFH) is immunogenic, and heparin-dependent antibodies can be demonstrated 5 to 10 days postoperatively in 25% to 50% of adult postcardiac surgery patients. In a minority of these cases (1% to 3% if UFH is continued longer than 1 week) these antibodies strongly activate platelets, causing thrombocytopenia and massive thrombin generation (HIT syndrome). HIT is an intensely procoagulant disorder, and in adult cardiac surgery patients carries both significant thrombotic morbidity (38% to 81%) and mortality (28%). Despite the ubiquitous use of UFH in pediatric intensive care units, and the repeated and sustained exposures to UFH in neonates and young children with congenital heart disease, HIT has been infrequently recognized and reported in this patient population. However, emerging experience at our institution and elsewhere suggests that HIT is significantly under-recognized in pediatric congenital heart disease patients, and may in fact have an incidence and associated thrombotic morbidity and mortality in this patient group comparable to that seen in adult cardiac surgery patients. This article will review HIT in pediatric patients with congenital heart disease and emphasize the special challenges posed in clinical recognition, laboratory diagnosis, and treatment of HIT in this patient group. We will also outline our experience with the off-label use of the direct thrombin inhibitor, argatroban, in pediatric patients with HIT.

Original languageEnglish (US)
Pages (from-to)155-171
Number of pages17
JournalPediatric Cardiac Surgery Annual
Volume7
Publication statusPublished - 2004

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Keywords

  • Congenital heart disease
  • Heparin-induced thrombocytopenia
  • Pediatric cardiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

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