TY  - BOOK
AU  - Chen, Fang
AU  - Corso, Paul J
AU  - Ellis, Jennifer
AU  - Hill, Peter C
AU  - Sun, Xiumei
AU  - Taylor-Panek, Sharon L
TI  - Ten-year screening for thrombocytopenia after aortic valve replacement
SN  - 1569-9285
KW  - *Aortic Valve/su [Surgery]
KW  - *Heart Valve Prosthesis Implantation/ae [Adverse Effects]
KW  - *Thrombocytopenia/et [Etiology]
KW  - Age Factors
KW  - Aged
KW  - Aged, 80 and over
KW  - Antibodies/bl [Blood]
KW  - Anticoagulants/im [Immunology]
KW  - Anticoagulants/tu [Therapeutic Use]
KW  - Biological Markers/bl [Blood]
KW  - Bioprosthesis
KW  - Enzyme-Linked Immunosorbent Assay
KW  - Female
KW  - Heart Valve Prosthesis
KW  - Heart Valve Prosthesis Implantation/is [Instrumentation]
KW  - Heart Valve Prosthesis Implantation/mo [Mortality]
KW  - Heparin/im [Immunology]
KW  - Heparin/tu [Therapeutic Use]
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Platelet Count
KW  - Platelet Factor 4/im [Immunology]
KW  - Predictive Value of Tests
KW  - Retrospective Studies
KW  - Risk Factors
KW  - Thrombocytopenia/bl [Blood]
KW  - Thrombocytopenia/di [Diagnosis]
KW  - Thrombocytopenia/im [Immunology]
KW  - Thrombocytopenia/mo [Mortality]
KW  - Time Factors
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Washington Hospital Center
KW  - Medicine
KW  - Journal Article
N2  - CONCLUSIONS: Thrombocytopenia and Elisa (+) are more common after AVR than after other procedures, and both were associated with increased adverse clinical outcomes. Age and lower preoperative platelet count were associated with postoperative thrombocytopenia and Elisa (+); METHODS: We have implemented a screening protocol since 2002. Cardiac surgery patients were postoperatively screened for thrombocytopenia. Thrombocytopenia was stratified by the anti-platelet factor 4/heparin antibody (enzyme-immune assay, Elisa) test. The presence of clinical embolithrombosis was sought in patients with antibodies. Preoperative and operative characteristics and outcomes were obtained from the departmental registry of cardiac surgical procedures; OBJECTIVES: Thrombocytopenia is very common after cardiac surgery, but rarely studied systematically. Heparin-induced thrombocytopenia has been studied extensively, but the diagnosis remains clouded by the lack of sensitivity and specificity of laboratory tests. It remains unknown whether a local initiative of screening program has been successful in the management of postoperative thrombocytopenia; RESULTS: A total of 16 529 patients were screened for thrombocytopenia from January 2003 to 2012. One thousand two hundred and sixty-one patients undergoing isolated aortic valve replacement (AVR) were included in this study. The overall incidence of thrombocytopenia after AVR was 26.8%. Elisa (+) occurred in 43 of the 1261 patients (3.4%), Elisa (+) plus thrombosis occurred in 14 (1.1%) and in 32.6% of Elisa (+) patients. Age and preoperative lower platelet count were independent predictors of thrombocytopenia. Elisa (+) alone was associated with increased operative mortality, stroke and bleeding. Patients developed thrombocytopenia and Elisa (+) were more likely to receive bioprosthetic valves
UR  - http://dx.doi.org/10.1093/icvts/ivt487
ER  -