Assessment of complications incidence in post cardiac surgery patients who developed heparin induced thrombocytopenia
Ayaganov D. Kuanyshbek A. Tulegenov S. Amanzholova A.
December 2025W.B. Saunders
Journal of Cardiothoracic and Vascular Anesthesia
2025#39Issue 1269 - 70 pp.
Objective: Heparin-induced thrombocytopenia (HIT) is a significant adverse reaction to anticoagulant therapy that can occur postoperatively in cardiac surgery patients. Preoperative heparin exposure, along with intraoperative dosing during cardiopulmonary bypass (CPB) and postoperative recovery, increases the risk of immunization against heparin-platelet factor 4 complexes, leading to prothrombotic activation of platelets and their increased consumption. Unfractionated heparin is widely used as anticoagulant therapy in cardiovascular disease. Its importance is particularly notable in the postoperative period for patients on extracorporeal circuits, where prolonged exposure to heparin is required. However, extended heparin use also elevates the risk of HIT. HIT is the most clinically significant and common drug-induced form of thrombocytopenia, associated with considerable morbidity and mortality if not promptly recognized. Given that thrombocytopenia is common in hospitalized patients and may have multifactorial causes in the postoperative period, HIT frequently goes unrecognized and undiagnosed. The aim of this study is to assess the incidence of HIT and its complications in post-cardiac surgery patients. Design and method: This single-center, retrospective, observational study included patients who developed HIT following cardiac surgery in the adult intensive care unit. Patients were selected based on the 4Ts scoring system, and assessed for complications such as mortality, bleeding, and ischemic events including acute kidney injury (AKI), mesenteric ischemia, and stroke. Results and conclusions: Out of 91 patients suspected of developing HIT, 38 were confirmed HIT-positive according to the 4Ts scoring system and subsequent immunologic screening. Mortality was observed in 39.4% (15 patients), bleeding in 21.1% (8 patients), and extracorporeal hemocorrection was required in 52.6% (20 patients). Thrombotic complications occurred in 23.7% (9 patients). Conclusion: Patients with HIT experience a range of complications, with mortality being the most serious and irreversible outcome. Although complications in post-cardiac surgery patients are multifactorial, the most frequent complication in patients with HIT was the need for extracorporeal hemocorrection.
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CF University Medical Center, Astana, Kazakhstan
CF University Medical Center
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