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Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass.
J Coll Physicians Surg Pak 2019; 29(10):986-992JC

Abstract

Heparin-induced thrombocytopenia (HIT) is an immune-mediated response to heparin administration. HIT following cardiopulmonary bypass (CPB) procedures has not been clearly delineated in pediatric populations. By comprehensive retrieval of the pertinent literature published since 2000, 19 reports were collected with 33 pediatric patients recruited into this study. A female predominance was noted in this patient setting. HIT occurred after a mean heparin exposure of 2.8 times. Pediatric HIT following CPB showed different features from that with no CPB, by a longer span on postoperative day 1-16, and a significant negative correlation between the platelet count and time of occurrence of thrombocytopenia on postoperative day 1-8. The thrombus formation developed on postoperative day 13. Heparin discontinuation and use of coganulant substitute are the important treatments of choice. In HIT patients, continued heparin use may cause patient death or recurrence of HIT. HIT-related thrombosis was present in 69.6% of the patients with similar incidence rates of arterial and venous thrombosis; and the thrombosis could be managed by medical, surgical or device explant methods. The direct thrombin inhibitors lepirudin, argatroban and bivalirudin as well as the factor Xa inhibitor danaparoid can be used safely in most of the pediatric patients. The event-free survival rate of this patient setting was 69.7%.

Authors+Show Affiliations

Division of Cardiac Surgery, Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31564275

Citation

Yuan, Shi-Min. "Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass." Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, vol. 29, no. 10, 2019, pp. 986-992.
Yuan SM. Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass. J Coll Physicians Surg Pak. 2019;29(10):986-992.
Yuan, S. M. (2019). Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 29(10), pp. 986-992. doi:10.29271/jcpsp.2019.10.986.
Yuan SM. Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass. J Coll Physicians Surg Pak. 2019;29(10):986-992. PubMed PMID: 31564275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass. A1 - Yuan,Shi-Min, PY - 2019/01/18/received PY - 2019/03/15/accepted PY - 2019/10/1/entrez PY - 2019/10/1/pubmed PY - 2019/10/1/medline SP - 986 EP - 992 JF - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP JO - J Coll Physicians Surg Pak VL - 29 IS - 10 N2 - Heparin-induced thrombocytopenia (HIT) is an immune-mediated response to heparin administration. HIT following cardiopulmonary bypass (CPB) procedures has not been clearly delineated in pediatric populations. By comprehensive retrieval of the pertinent literature published since 2000, 19 reports were collected with 33 pediatric patients recruited into this study. A female predominance was noted in this patient setting. HIT occurred after a mean heparin exposure of 2.8 times. Pediatric HIT following CPB showed different features from that with no CPB, by a longer span on postoperative day 1-16, and a significant negative correlation between the platelet count and time of occurrence of thrombocytopenia on postoperative day 1-8. The thrombus formation developed on postoperative day 13. Heparin discontinuation and use of coganulant substitute are the important treatments of choice. In HIT patients, continued heparin use may cause patient death or recurrence of HIT. HIT-related thrombosis was present in 69.6% of the patients with similar incidence rates of arterial and venous thrombosis; and the thrombosis could be managed by medical, surgical or device explant methods. The direct thrombin inhibitors lepirudin, argatroban and bivalirudin as well as the factor Xa inhibitor danaparoid can be used safely in most of the pediatric patients. The event-free survival rate of this patient setting was 69.7%. SN - 1681-7168 UR - https://www.unboundmedicine.com/medline/citation/31564275/Heparin-induced_Thrombocytopenia_in_Pediatrics_Following_Cardiopulmonary_Bypass DB - PRIME DP - Unbound Medicine ER -
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