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Ten-year screening for thrombocytopenia after aortic valve replacement.
[heparin-induced thrombocytopenia]
Thrombocytopenia
is
very
common
after
cardiac
surgery
,
but
rarely
studied
systematically
.
Heparin-induced
thrombocytopenia
has
been
studied
extensively
,
but
the
diagnosis
remains
clouded
by
the
lack
of
sensitivity
and
specificity
of
laboratory
tests
.
It
remains
unknown
whether
a
local
initiative
of
screening
program
has
been
successful
in
the
management
of
postoperative
thrombocytopenia
.
We
have
implemented
a
screening
protocol
since
2002
.
Cardiac
surgery
patients
were
postoperatively
screened
for
thrombocytopenia
.
Thrombocytopenia
was
stratified
by
the
anti-
platelet
factor
4
/
heparin
antibody
(
enzyme-immune
assay
,
Elisa
)
test
.
The
presence
of
clinical
embolithrombosis
was
sought
in
patients
with
antibodies
.
Preoperative
and
operative
characteristics
and
outcomes
were
obtained
from
the
departmental
registry
of
cardiac
surgical
procedures
.
A
total
of
16
529
patients
were
screened
for
thrombocytopenia
from
January
2003
to
2012
.
One
thousand
two
hundred
and
sixty-
one
patients
undergoing
isolated
aortic
valve
replacement
(
AVR
)
were
included
in
this
study
.
The
overall
incidence
of
thrombocytopenia
after
AVR
was
26
.
8
%
.
Elisa
(
+
)
occurred
in
43
of
the
1261
patients
(
3
.
4
%
)
,
Elisa
(
+
)
plus
thrombosis
occurred
in
14
(
1
.
1
%
)
and
in
32
.
6
%
of
Elisa
(
+
)
patients
.
Age
and
preoperative
lower
platelet
count
were
independent
predictors
of
thrombocytopenia
.
Elisa
(
+
)
alone
was
associated
with
increased
operative
mortality
,
stroke
and
bleeding
.
Patients
developed
thrombocytopenia
and
Elisa
(
+
)
were
more
likely
to
receive
bioprosthetic
valves
.
Thrombocytopenia
and
Elisa
(
+
)
are
more
common
after
AVR
than
after
other
procedures
,
and
both
were
associated
with
increased
adverse
clinical
outcomes
.
Age
and
lower
preoperative
platelet
count
were
associated
with
postoperative
thrombocytopenia
and
Elisa
(
+
)
.
Diseases
Validation
Diseases presenting
"heparin-induced thrombocytopenia"
symptom
heparin-induced thrombocytopenia
This symptom has already been validated