Recognition and management of heparin-induced thrombocytopenia in pediatric cardiopulmonary bypass patients

Ann Thorac Surg. 2006 Jun;81(6):S2355-9. doi: 10.1016/j.athoracsur.2006.02.075.

Abstract

Repeated exposure to unfractionated heparin is the rule in many congenital heart disease patients. Heparin-induced thrombocytopenia occurs in 1% to 3% of adult cardiac surgeries, and carries high thrombotic morbidity (38% to 81%) and mortality (approximately 28%). Although heparin-induced thrombocytopenia appears to be infrequent in pediatric patients, particularly neonates, our evolving experience suggests postcardiopulmonary bypass congenital heart disease patients may be at increased risk. Diagnostic and therapeutic challenges include frequency of thrombocytopenia after cardiopulmonary bypass, imperfect laboratory testing, lack of established dosing of alternative anticoagulants (such as argatroban and lepirudin), and increased anticoagulant-related bleeding in young children.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Anticoagulants / adverse effects*
  • Arginine / analogs & derivatives
  • Autoantibodies / biosynthesis
  • Autoantibodies / immunology
  • Cardiopulmonary Bypass*
  • Child
  • Child, Preschool
  • Clinical Trials as Topic
  • Fatal Outcome
  • Female
  • Heart Defects, Congenital / blood
  • Heart Defects, Congenital / surgery
  • Heparin / adverse effects*
  • Hirudins
  • Hospitals, University / statistics & numerical data
  • Humans
  • Hypoplastic Left Heart Syndrome / blood
  • Hypoplastic Left Heart Syndrome / surgery
  • Infant
  • Infant, Newborn
  • Male
  • Multicenter Studies as Topic
  • Pipecolic Acids / administration & dosage
  • Pipecolic Acids / therapeutic use
  • Platelet Factor 4 / chemistry
  • Platelet Factor 4 / immunology
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / drug therapy
  • Postoperative Complications / prevention & control
  • Postoperative Hemorrhage / etiology
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • Sulfonamides
  • Thrombocytopenia / chemically induced*
  • Thrombocytopenia / diagnosis
  • Thrombocytopenia / drug therapy
  • Thrombocytopenia / immunology
  • Thromboembolism / prevention & control
  • Treatment Outcome

Substances

  • Anticoagulants
  • Autoantibodies
  • Hirudins
  • Pipecolic Acids
  • Recombinant Proteins
  • Sulfonamides
  • Platelet Factor 4
  • Heparin
  • Arginine
  • argatroban
  • lepirudin