Reduced morbidity and mortality rates of the heparin-induced thrombocytopenia syndrome

J. I. Alimeida, R. Coats, Timothy Liem, D. Silver, M. Sobel

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Purpose: We reported a 61% morbidity rate and a 23% mortality rate for the heparininduced thrombocytopenia (HIT) syndrome in 1983. We subsequently reported in 1987 that with early recognition, immediate cessation of the administration of heparin, and platelet function inhibition, the morbidity rate could be reduced to 23% and the mortality rate to 12%. One hundred recent cases of patients with heparin-associated antiplatelet antibodies (HAAb) have been reviewed to determine whether aggressive screening; early diagnosis, and alternate management could further reduce morbidity and mortality rates. Methods: The consecutive records of 100 patients with positive platelet aggregation tests were reviewed. Sixty-six patients were male. The patients' ages ranged from 23 days to 92 years. The patients were from vascular (28), cardiothoracic (42), and other (30) services. HIT was suspected in patients who received heparin and had falling platelet counts, platelet counts less than 100,000/mm3, or new thromboembolic or hemorrhagic events. Results: Heparin was not offered to six patients with known HAAb. Twelve patients were successfully treated with antiplatelet therapy and limited reexposure to heparin, and 75 patients were successfully treated with early diagnosis and prompt cessation of heparin. Alternate forms of anticoagulation therapy were used selectively. Seven patients had 11 complications. Three of the seven patients were treated successfully with warfarin anticoagulation and aspirin (2) or with aspirin alone (1). A fourth patient was treated with thrombectomy, hematoma evacuation, and aspirin. A fifth patient underwent thrombolysis and coronary angioplasty in addition to receiving warfarin and aspirin. The sixth patient required two thrombectomies and warfarin. A seventh patient required two thrombectomies and aspirin. HIT was responsible for one of 17 deaths. Conclusion: A 7.4% morbidity rate and a 1.1% mortality rate have been achieved in patients with HAAb by aggressive screening, early recognition of HIT, and prompt cessation of the administration of heparin. Platelet function inhibitors and other anticoagulants, including nonreacting low molecular weight heparin, are important adjuncts in the management of the thromboembolic disorders associated with HIT.

Original languageEnglish (US)
Pages (from-to)309-316
Number of pages8
JournalJournal of Vascular Surgery
Volume27
Issue number2
DOIs
StatePublished - 1998
Externally publishedYes

Fingerprint

Thrombocytopenia
Heparin
Morbidity
Mortality
Aspirin
Thrombectomy
Warfarin
Platelet Count
Antibodies
Early Diagnosis
Accidental Falls
Low Molecular Weight Heparin
Platelet Aggregation Inhibitors
Platelet Aggregation
Angioplasty
Hematoma
Anticoagulants
Blood Vessels
Blood Platelets

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Reduced morbidity and mortality rates of the heparin-induced thrombocytopenia syndrome. / Alimeida, J. I.; Coats, R.; Liem, Timothy; Silver, D.; Sobel, M.

In: Journal of Vascular Surgery, Vol. 27, No. 2, 1998, p. 309-316.

Research output: Contribution to journalArticle

Alimeida, J. I. ; Coats, R. ; Liem, Timothy ; Silver, D. ; Sobel, M. / Reduced morbidity and mortality rates of the heparin-induced thrombocytopenia syndrome. In: Journal of Vascular Surgery. 1998 ; Vol. 27, No. 2. pp. 309-316.
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