Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Vascular Surgery

Chaudhry, Rabail; Wegner, Robert; Zaki, John; Pednekar, Greesha; Tse, Alex; Kukreja, Naveen; Grewal, Navneet; Williams, George W.

doi:10.1053/j.jvca.2017.05.024

Cited by 27 publications

(27 citation statements)

References 13 publications

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“…There have been controversial conclusions about the risk factors of HIT. In contrast to our results, Warkentin et al 28 and Chaudhry et al 29 found the female gender as a risk factor to HIT. This may be due to the different immune responses after various surgeries 29 , or the different thromboprophylactic therapies employed.…”

Section: Discussioncontrasting

confidence: 99%

“…In contrast to our results, Warkentin et al 28 and Chaudhry et al 29 found the female gender as a risk factor to HIT. This may be due to the different immune responses after various surgeries 29 , or the different thromboprophylactic therapies employed. 28 The racial differences 30 and polymorphism variabilities 31 have also been reported by other researchers.…”

Section: Discussioncontrasting

confidence: 99%

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Incidence, Outcomes and Risk Factors of Heparin-Induced Thrombocytopenia after Total Joint Arthroplasty: An Analysis of the National Inpatient Sample Database

Chen

Wang

Shi

et al. 2020

Preprint

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Abstract Background Heparin-induced thrombocytopenia (HIT) is a severe immune-mediated complication of heparin exposure, leading to negative consequences after total hip (THA) and knee arthroplasty (TKA). However, the incidence and risk factors of HIT remain to be elucidated. This study aimed to identify the incidence, outcomes, and risk factors of HIT after THA and TKA. Methods A retrospective study was conducted using the National Inpatient Sample (NIS) database from 2005 to 2014. The incidence and outcomes of HIT after THA or TKA were documented. Logistic regression analysis was performed to identify the postoperative HIT risk factors. Results A total of 593,045 patients who underwent THA and 1,228,707 patients who underwent TKA were identified. The cumulative incidences were 0.02% and 0.01%, respectively. The HIT group presented significantly higher Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) scores, longer hospital stays (LOS), and higher medical costs. HIT led to a significantly higher mortality rate after THA (2.17% vs. 0.16%, p =0.0091). Although not statistically significant, the HIT mortality rate after TKA was also increased (0.58% vs. 0.07%; p =0.1178). In THA, the risk factors of HIT were racial minority, AIDS, pulmonary circulation disorders (PCD), psychoses, and hypertension; the protective factors were large-scale and teaching hospitals. In TKA, the HIT risk factors were racial minority, PCD, and weight loss. Teaching hospitals served as protective factors. Conclusions The incidence of HIT after THA and TKA is relatively low; however, HIT significantly increases inpatient mortality, LOS, and medical cost. Therefore, HIT warrants considerable attention and further investigation.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Incidence, Outcomes and Risk Factors of Heparin-Induced Thrombocytopenia after Total Joint Arthroplasty: An Analysis of the National Inpatient Sample Database

Chen

Wang

Shi

et al. 2020

Preprint

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“…Moreover, heparin-induced thrombocytopenia is a potentially life-threatening condition that affects 0.3% of patients after UFH application in vascular procedures. 1 Bivalirudin (BIV) was found to have the advantages of inhibiting fibrin-bound thrombin, a predictable effect of anticoagulation, and a short half-life of approximately 30 minutes in humans with normal renal function. 2,3 BIV, a synthetic, bivalent, 20-amino acid direct thrombin inhibitor, was first introduced in percutaneous coronary interventions (PCIs) in the early 1990s.…”

mentioning

confidence: 99%

A systematic review and meta-analysis of bivalirudin application in peripheral endovascular procedures

Liu

Zhang

et al. 2019

Journal of Vascular Surgery

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Objective: The direct thrombin inhibitor bivalirudin (BIV) was shown to be superior to unfractionated heparin (UFH) in percutaneous coronary interventions for reducing procedural blood loss. The aim of this study was to compare outcome profiles of BIV and UFH in peripheral endovascular procedures (PEPs) by synthesizing the currently available data. Methods: Following the PRISMA statement, we conducted a comprehensive literature search using Medline, Cochrane CENTRAL, PubMed, EMBASE, CINAHL Google scholar, and clinicaltrials.gov. We recruited randomized, controlled trials and well-conducted observational studies that compared UFH and BIV in PEPs requiring anticoagulation, excluding endovascular cardiac procedures and coronary interventions. Random-effects meta-analyses were conducted to compare the outcome profiles of these two agents. Results: Thirteen articles containing 17 studies involving a total of 21,057 patients were enrolled. Of these, 2 were randomized controlled trials, 2 were prospective cohort studies, and 10 were retrospective studies. There were no significant differences between BIV and UFH in terms of procedural success rates, major and minor perioperative bleeding, transfusion, perioperative transient ischemic attack, or hemorrhagic strokes. However, compared with UFH, BIV had significantly lower odds ratios (OR) of perioperative mortality (OR, 0.58; 95% confidence interval [CI], 0.40-0.86), major adverse cardiovascular events (OR, 0.65; 95% CI, 0.51-0.83), net adverse clinical events (OR, 0.75; 95% CI, 0.63-0.88), perioperative myocardial infarction (OR, 0.73; 95% CI, 0.55-0.98), major vascular complications (OR, 0.59; 95% CI, 0.39-0.91), and minor vascular complications (OR, 0.58; 95% CI, 0.40-0.84). Conclusions: Compared with UFH, PEPs using BIV had comparable procedural success rates and odds of perioperative transient ischemic attack and hemorrhagic stroke. However, procedures with BIV had a lower but nonsignificant odds of perioperative bleeding and transfusion. Depending on the procedures conducted, the patients who received BIV will have reduced or comparable odds of perioperative mortality, myocardial infarction, major adverse cardiovascular events, net adverse clinical events, and major and minor vascular complications. Therefore, BIV may be chosen solely as an alternative procedural anticoagulant to UFH for PEPs. (

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“…Clinical features such as lymphadenopathy, hepatomegaly, splenomegaly, jaundice and anaemia should be sought,13 and any child with an abnormal blood film or deficiencies in multiple cell lines should be discussed with the local haematology service.…”

Section: Aetiologymentioning

confidence: 99%

Fifteen-minute consultation: the child with a non-blanching rash

Waterfield

Dyer

Lyttle

2018

Arch Dis Child Educ Pract Ed

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Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Vascular Surgery

Cited by 27 publications

References 13 publications

Incidence, Outcomes and Risk Factors of Heparin-Induced Thrombocytopenia after Total Joint Arthroplasty: An Analysis of the National Inpatient Sample Database

Incidence, Outcomes and Risk Factors of Heparin-Induced Thrombocytopenia after Total Joint Arthroplasty: An Analysis of the National Inpatient Sample Database

A systematic review and meta-analysis of bivalirudin application in peripheral endovascular procedures

Fifteen-minute consultation: the child with a non-blanching rash

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