TY - JOUR
T1 - Heparin-induced thrombocytopenia (HIT) in pediatric cardiac surgery
T2 - An emerging cause of morbidity and mortality
AU - Alsoufi, Bahaaldin
AU - Boshkov, Lynn
AU - Kirby, Aileen
AU - Ibsen, Laura
AU - Dower, Nancy
AU - Shen, Irving
AU - Ungerleider, Ross
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2004
Y1 - 2004
N2 - 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.
AB - 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.
KW - Congenital heart disease
KW - Heparin-induced thrombocytopenia
KW - Pediatric cardiology
UR - http://www.scopus.com/inward/record.url?scp=2542502694&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=2542502694&partnerID=8YFLogxK
U2 - 10.1053/j.pcsu.2004.02.024
DO - 10.1053/j.pcsu.2004.02.024
M3 - Article
C2 - 15283365
AN - SCOPUS:2542502694
SN - 1092-9126
VL - 7
SP - 155
EP - 171
JO - Pediatric Cardiac Surgery Annual
JF - Pediatric Cardiac Surgery Annual
IS - 1
ER -