Long-term outcomes of heparin-induced thrombocytopenia after cardiac surgery

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heparin-induced thrombocytopenia (HIT) after cardiac surgery (n=88). Intervention: Postoperative heparin-induced thrombocytopenia (HIT). Primary outcome: 10-year survival probability in the overall HIT cohort.

Q: What does this research mean for the field?

Heparin-induced thrombocytopenia after cardiac surgery is associated with poor long-term outcomes among hospital discharge survivors, resulting in a 70.1% readmission rate and a 47.8% 10-year survival probability. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Emily Rodriguez; Maria Daskam; Benjamin L. Shou; Charles Woodrum; Ria Gupta; Kathryn Dane; Diane Alejo; Marc Sussman; Stefano Schena

doi:10.1016/j.xjon.2024.10.029

November 10, 2024JTCVS OpenOpen Access

Long-term outcomes of heparin-induced thrombocytopenia after cardiac surgery

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Key result

Postoperative heparin-induced thrombocytopenia is linked to ~48% 10-year survival following cardiac surgery.

n=88

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Why the study?

Heparin-induced thrombocytopenia (HIT) after cardiac surgery may lead to greater morbidity and mortality than predicted preoperatively, motivating an assessment of long-term outcomes in survivors.

Key Points

To assess the long-term morbidity, readmissions, and survival of adult patients who survived heparin-induced thrombocytopenia (HIT) after cardiac surgery.
Single-institution retrospective study evaluating 11,658 adult patients who underwent cardiac surgery using cardiopulmonary bypass between 2011 and 2023.
Postoperative HIT was defined by a platelet decrease >50%, a high optical density positive heparin-PF4 antibody test, and a positive serotonin release assay alongside 4Ts scores.
Outcomes were tracked via the Society of Thoracic Surgeons database, electronic records, and telephone questionnaires over a median follow-up of 4.6 [0.3-12] years.
Postoperative HIT occurred in 88 of 11,658 patients (0.8%), with an index hospitalization mortality of 12.5% (n = 11) and 77 patients (87.5%) surviving to discharge.
Among discharge survivors, 70.1% (n = 54) experienced hospital readmissions, averaging 3 [1-6] readmissions per patient, with cumulative readmission hazards of 1.3 at 1 year and 3.1 at 10 years.
New prothrombotic complications occurred in 74.0% (n = 57) of patients, and the overall 10-year survival probability was 48% (47.8%).

Study Design

Type

Cohort (n=88)

Multicenter

No

Structured PICO

P

Population

88 adult cardiac surgery patients who developed postoperative heparin-induced thrombocytopenia (77 surviving to discharge), mean age 65.6 years, 25.0% female, followed for a median of 4.6 years.

E

Exposure

Postoperative management of heparin-induced thrombocytopenia (HIT), including discontinuation of heparin, transition to intravenous bivalirudin infusion as bridge therapy, and discharge on oral anticoagulation (77.9% of survivors discharged on anticoagulation: 67.5% warfarin, 6.5% direct oral anticoagulants, 3.9% other; 28.6% maintained beyond 3 months for a median of 1.3 [0.8-4.5] years).

O

Outcome

Long-term survival/mortality, hospital readmissions, and postdischarge prothrombotic complications (vascular events, renal complications, pulmonary embolism, and stroke) over a median follow-up of 4.6 [0.3-12] years.hard clinical

Patients who survive to hospital discharge after developing heparin-induced thrombocytopenia following cardiac surgery remain at high risk for recurrent prothrombotic complications, frequent readmissions (70.1%), and poor 10-year survival (47.8%), highlighting the need for closer post-discharge surveillance and potentially extended anticoagulation.

Limitations

Retrospective nature relying on electronic medical records and phone-administered surveys, introducing potential recollection bias and data incompleteness
Single-arm investigation lacking a comparator or propensity-matched control group
Single, tertiary academic center design limiting generalizability to other settings
Small sample size due to the low incidence of HIT, limiting statistical power
Single-arm investigation without a comparator group (e.g., propensity-matched controls)
Single, tertiary academic center design, which may limit generalizability to other settings
Small sample size due to the rarity and low incidence of HIT, limiting statistical significance of associations and differences

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Implication

HIT survivors after cardiac surgery face high long-term risk; this Level 3 association leaves open whether intensified surveillance improves outcomes.

Abstract

Objective: Heparin-induced thrombocytopenia (HIT) after cardiac surgery may lead to greater morbidity and mortality than predicted preoperatively. The aim of this study is to assess long-term outcomes of patients surviving HIT after cardiac surgery. Methods: Single-institution, retrospective study of adult patients who underwent cardiac surgery between 2011 and 2023 and developed HIT postoperatively. The institutional Society of Thoracic Surgeons database and electronic medical record were integrated with longitudinal data from phone questionnaires. HIT was defined by combined clinical (4Ts score) and serologic manifestations: a platelet decrease >50% from preoperative baseline, a high optical density positive heparin-PF4 antibody test, and a positive serotonin release assay. Results: We identified 88 of 11,658 patients (0.8%) with HIT after cardiac surgery. The majority were male (74%), white (73.8%), and with a mean age of 65.6 ± 11.6 years. Seventy-seven (87.5%) survived to discharge, had a 4Ts score of 5 [4-6], and 58 (75.3%) were discharged on oral anticoagulation, with only 22 (28.6%) receiving treatment for the past 3 months, for a median of 1.3 [0.8-4.5] years. Median length of stay was 24 [17-35] days and length of follow-up was 4.6 [0.3-12] years. Readmission occurred in 70.1% (n = 54) of patients, with an average of 3 [1-6] readmissions/patient. Causes of death during follow-up included cardiac (n = 7, 24.1%), infectious (n = 6, 20.7%), or neurologic events (n = 5, 17.3). Ten-year survival probability was 48%. Conclusions: Patients who develop HIT after cardiac surgery have an overall poor prognosis even after hospital discharge. In addition to prolonged hospitalization, patients experience further complications leading to frequent early readmissions and elevated mortality in the long-term.

Discussion

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Cite This Study

Rodriguez et al. (2024) conducted a cohort in Heparin-induced thrombocytopenia (HIT) after cardiac surgery (n=88). Postoperative heparin-induced thrombocytopenia (HIT) was evaluated on 10-year survival probability in the overall HIT cohort. Heparin-induced thrombocytopenia after cardiac surgery was associated with a 47.8% 10-year survival probability and a 70.1% hospital readmission rate among discharge survivors.

synapsesocial.com/papers/6a7753c7e29fd788c9f737a3 https://doi.org/10.1016/j.xjon.2024.10.029

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Long-term outcomes of heparin-induced thrombocytopenia after cardiac surgery

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Long-term outcomes of heparin-induced thrombocytopenia after cardiac surgery

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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