Heparin-induced thrombocytopenia (HIT) in pediatric cardiac surgery: an emerging cause of morbidity and mortality

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…It has been described in pediatric patients but may be less prevalent or less severe. [423][424][425][426] In patients with a recent history of HIT requiring cardiac surgery, alternatives to heparin may be necessary. Alternatives to heparin in pediatric patients undergoing operations with CPB include danaparoid and the direct thrombin inhibitors argatroban and bivalirudin.…”

When Heparins Promote Thrombosis

“…6 However, orthopedic surgery patients, despite having a lower frequency of HIT antibodies, are more likely than cardiac surgery patients to develop HIT. 14 In cardiac surgery patients, the frequency of HIT in pediatrics (1.3%) 24 is generally comparable to that estimated in adults in combined-study analyses (Ϸ2.4%). 25 Prospective studies indicate that HIT occurs in Ϸ0.3% to 3% of medical patients receiving heparin therapy.…”

“…97 Limited data exist on the use of recombinant factor VIIa as a nonspecific antidote for treating severe bleeding in patients with HIT. 24,98 Symptomatic and supportive care should be given.…”

“…24 However, a retrospective analysis of published cases found that death or limb amputation occurred in 42% of pediatric HIT patients without therapy, compared with 18% treated with lepirudin, argatroban, or danaparoid. 39 Although not systematically studied, neonates and children, in whom drugs often have different pharmacokinetics than in adults, appear to require greater doses of the alternative anticoagulants than do adults.…”

“…39 Although not systematically studied, neonates and children, in whom drugs often have different pharmacokinetics than in adults, appear to require greater doses of the alternative anticoagulants than do adults. 24,67 A study is ongoing in the United States to evaluate argatroban anticoagulation, including its pharmacokinetics, in pediatric patients in whom heparin use is problematic.…”