Key result
Postoperative heparin-induced thrombocytopenia in non-CABG cardiac surgery patients was associated with significantly higher unadjusted 30-day mortality (14.8% vs 4.9%, P<0.01).
Why the study?
While HIT incidence and outcomes are well defined for general cardiac surgical populations, outcomes in patients excluding those undergoing CABG remained to be defined.
Does postoperative heparin-induced thrombocytopenia worsen morbidity and mortality in patients undergoing open valvular or aortic surgery?
Cohort (n=8,107)
No
Does postoperative heparin-induced thrombocytopenia worsen morbidity and mortality in patients undergoing open valvular or aortic surgery?
Absolute Event Rate: 14.8% vs 4.9%
p-value: p=<0.01
Postoperative heparin-induced thrombocytopenia is associated with significantly increased 30-day mortality and morbidity in patients undergoing valvular and aortic surgery.
Supports closer HIT monitoring after valvular/aortic surgery; leaves open whether the association is causal or modifiable.
Objective The incidence and outcomes of patients with heparin-induced thrombocytopenia (HIT) are well defined for general cardiac surgical populations. The purpose of this study was to define the outcomes of patients with HIT in a population excluding patients who underwent coronary artery bypass grafting (CABG). Methods The local Society of Thoracic Surgeons cardiac surgical database was queried between January 2008 and May 2017 for patients who underwent either open valvular surgery or aortic surgery. Patients who underwent either isolated or combined CABG procedures were excluded. Cohorts were formed based on the presence or absence of postoperative HIT. Logistic regression models were built to determine the association between postoperative HIT and outcomes, adjusted for both preoperative and intraoperative variables. Results Of the total cohort (8,107 patients), 176 patients (2.2%) developed HIT after surgery. HIT patients experienced an increased incidence of morbidities postoperatively, including reoperation for bleeding, reoperation for cardiac and noncardiac etiologies, postoperative stroke, perioperative myocardial infarction, postoperative sternal infection, postoperative arrhythmia, new-onset renal failure, and dialysis (all with P < 0.01). The unadjusted 30-day mortality was 14.8% in HIT patients vs 4.9% in those without HIT ( P < 0.01). After risk adjustment, reoperation for noncardiac events, renal failure, new dialysis, postoperative stroke, arrhythmia, and sternal wound infection remained significantly elevated in patients who developed postoperative HIT. Conclusions Patients who developed HIT after non-CABG cardiac surgery experienced increased postoperative rates of morbidity and mortality. Early diagnosis and treatment remained mainstays of therapy. Early identification of patients at highest risk should prompt careful risk stratification when possible.
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Zapata et al. (2020) conducted a cohort in Heparin-induced thrombocytopenia (n=8,107). Postoperative heparin-induced thrombocytopenia vs. Absence of postoperative heparin-induced thrombocytopenia was evaluated on 30-day mortality (p=<0.01). Postoperative heparin-induced thrombocytopenia in non-CABG cardiac surgery patients was associated with significantly higher unadjusted 30-day mortality (14.8% vs 4.9%, P<0.01).
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