Ten-year screening for thrombocytopenia after aortic valve replacement.

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Citation: Interactive Cardiovascular & Thoracic Surgery. 18(5):562-7, 2014 May.PMID: 24497605Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve/su [Surgery] | *Heart Valve Prosthesis Implantation/ae [Adverse Effects] | *Thrombocytopenia/et [Etiology] | Age Factors | Aged | Aged, 80 and over | Antibodies/bl [Blood] | Anticoagulants/im [Immunology] | Anticoagulants/tu [Therapeutic Use] | Biological Markers/bl [Blood] | Bioprosthesis | Enzyme-Linked Immunosorbent Assay | Female | Heart Valve Prosthesis | Heart Valve Prosthesis Implantation/is [Instrumentation] | Heart Valve Prosthesis Implantation/mo [Mortality] | Heparin/im [Immunology] | Heparin/tu [Therapeutic Use] | Humans | Male | Middle Aged | Platelet Count | Platelet Factor 4/im [Immunology] | Predictive Value of Tests | Retrospective Studies | Risk Factors | Thrombocytopenia/bl [Blood] | Thrombocytopenia/di [Diagnosis] | Thrombocytopenia/im [Immunology] | Thrombocytopenia/mo [Mortality] | Time Factors | Treatment OutcomeISSN:
  • 1569-9285
Name of journal: Interactive cardiovascular and thoracic surgeryAbstract: 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.All authors: Chen F, Corso PJ, Ellis J, Hill PC, Sun X, Taylor-Panek SLDigital Object Identifier: Date added to catalog: 2015-03-17
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Journal Article MedStar Authors Catalog Article Available 24497605

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.

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