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Contaminated heparin and outcomes after cardiac surgery: a retrospective propensity-matched cohort study.
[heparin-induced thrombocytopenia]
During
2007
and
2008
it
is
likely
that
millions
of
patients
in
the
US
received
heparin
contaminated
(
CH
)
with
oversulfated
chondroitin
sulfate
,
which
was
associated
with
anaphylactoid
reactions
.
We
tested
the
hypothesis
that
CH
was
associated
with
serious
morbidity
,
mortality
,
intensive
care
unit
(
ICU
)
stay
and
heparin-induced
thrombocytopenia
following
adult
cardiac
surgery
.
We
conducted
a
single
center
,
retrospective
,
propensity-matched
cohort
study
during
the
period
of
CH
and
the
equivalent
time
frame
in
the
three
preceding
or
the
two
following
years
.
Perioperative
data
were
obtained
from
the
institutional
record
of
the
Society
of
Thoracic
Surgeons
National
Database
,
for
which
the
data
collection
is
prospective
,
standardized
and
performed
by
independent
investigators
.
After
matching
,
logistic
regression
was
performed
to
evaluate
the
independent
effect
of
CH
on
the
composite
adverse
outcome
(
myocardial
infarction
,
stroke
,
pneumonia
,
dialysis
,
cardiac
arrest
)
and
on
mortality
.
Cox
regression
was
used
to
determine
the
association
between
CH
and
ICU
length
of
stay
.
The
1
∶
5
matched
groups
included
220
patients
potentially
exposed
to
CH
and
918
controls
.
There
were
more
adverse
outcomes
in
the
exposed
cohort
(
20
.
9
%
versus
12
.
0
%
;
difference
=
8
.
9
%
;
95
%
CI
3
.
6
%
to
15
.
1
%
,
P
<
0
.
001
)
with
an
odds
ratio
for
CH
of
2
.
0
(
95
%
CI
,
1
.
4
to
3
.
0
,
P
<
0
.
001
)
.
In
the
exposed
group
there
was
a
non-significant
increase
in
mortality
(
5
.
9
%
versus
3
.
5
%
,
difference
=
2
.
4
%
;
95
%
CI
,
-
0
.
4
to
3
.
5
%
,
P
=
0
.
1
)
,
the
median
ICU
stay
was
longer
by
14
.
1
hours
(
interquartile
range
-
26
.
6
to
79
.
8
,
S
=
3299
,
P
=
0
.
0004
)
with
an
estimated
hazard
ratio
for
CH
of
1
.
2
(
95
%
CI
,
1
.
0
to
1
.
4
,
P
=
0
.
04
)
.
There
was
no
difference
in
nadir
platelet
counts
between
cohorts
.
The
results
from
this
single
center
study
suggest
the
possibility
that
contaminated
heparin
might
have
contributed
to
serious
morbidity
following
cardiac
surgery
.
Diseases
Validation
Diseases presenting
"pneumonia"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
allergic bronchopulmonary aspergillosis
alpha-thalassemia
classical phenylketonuria
cohen syndrome
congenital diaphragmatic hernia
heparin-induced thrombocytopenia
hydrocephalus with stenosis of the aqueduct of sylvius
junctional epidermolysis bullosa
lamellar ichthyosis
legionellosis
liposarcoma
lymphangioleiomyomatosis
monosomy 21
oculocutaneous albinism
omenn syndrome
pleomorphic liposarcoma
primary effusion lymphoma
proteus syndrome
pyomyositis
scrub typhus
severe combined immunodeficiency
triple a syndrome
waldenström macroglobulinemia
wiskott-aldrich syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated