Heparin-Induced Thrombocytopenia in Patients Suffering Cardiogenic Shock

Lüsebrink, Enzo ; Lanz, Hugo; Binzenhöfer, Leonhard; Hoffmann, Sabine ; Höpler, Julia; Kraft, Marie; Gade, Nils; Gmeiner, Jonas; Roden, Daniel; Saleh, Inas; Hagl, Christian; Nickenig, Georg; Massberg, Steffen ; Zimmer, Sebastian; Jamin, Raúl Nicolás und Scherer, Clemens (2024): Heparin-Induced Thrombocytopenia in Patients Suffering Cardiogenic Shock. In: Critical Care Explorations, Bd. 6, Nr. 7, e1117

Abstract

Objectives: Cardiogenic shock (CS) is associated with high mortality. Patients treated for CS mostly require heparin therapy, which may be associated with com plications such as heparin-induced thrombocytopenia (HIT). HIT represents a se rious condition associated with platelet decline and increased hypercoagulability and remains a poorly researched field in intensive care medicine. Primary purpose of this study was to: 1) determine HIT prevalence in CS, 2) assess the perfor mance of common diagnostic tests for the workup of HIT, and 3) compare out comes in CS patients with excluded and confirmed HIT. DESIGN: Retrospective dual-center study including adult patients 18 years old or older with diagnosed CS and suspected HIT from January 2010 to November 2022. Setting: Cardiac ICU at the Ludwig-Maximilians University hospital in Munich and the university hospital of Bonn. Patients and interventions: In this retrospective analysis, adult patients with diagnosed CS and suspected HIT were included. Differences in baseline characteristics, mortality, neurologic and safety outcomes between patients with excluded and confirmed HIT were evaluated. Measurements and main results: In cases of suspected HIT, posi tive screening antibodies were detected in 159 of 2808 patients (5.7%). HIT was confirmed via positive functional assay in 57 of 2808 patients, corresponding to a prevalence rate of 2.0%. The positive predictive value for anti-platelet fac tor 4/heparin screening antibodies was 35.8%. Total in-hospital mortality (58.8% vs. 57.9%; p > 0.999), 1-month mortality (47.1% vs. 43.9%; p = 0.781), and 12-month mortality (58.8% vs. 59.6%; p > 0.999) were similar between patients with excluded and confirmed HIT, respectively. Furthermore, no significant dif ference in neurologic outcome among survivors was found between groups (Cerebral Performance Category [CPC] score 1: 8.8% vs. 8.8%; p > 0.999 and CPC 2: 7.8% vs. 12.3%; p = 0.485). Conclusions: HIT was a rare complication in CS patients treated with unfrac tionated heparin and was not associated with increased mortality. Also, HIT con firmation was not associated with worse neurologic outcome in survivors. Future studies should aim at developing more precise, standardized, and cost-effective strategies to diagnose HIT and prevent complications.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin > Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie ; Medizin > Klinikum der LMU München > Herzchirurgische Klinik und Poliklinik ; Medizin > Klinikum der LMU München > Medizinische Klinik und Poliklinik I (Kardiologie)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 2639-8028
• Sprache: Englisch