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Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Large Impella for Acute Cardiogenic Shock

Despite the critical feature of heparin-induced thrombocytopenia (HIT) for patients on mechanical circulatory support, reports on its incidence and outcome are still scarce. Thus, we report on clinical features of HIT in patients under Impella 5.0 or 5.5 (Abiomed Inc., Danvers, MA, USA) (Impella 5+)...

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Autores principales: Sugimura, Yukiharu, Bauer, Sebastian, Immohr, Moritz Benjamin, Hermsen, Derik Franz, Westenfeld, Ralf, Boeken, Udo, Aubin, Hug, Tudorache, Igor, Lichtenberg, Artur, Akhyari, Payam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8709300/
https://www.ncbi.nlm.nih.gov/pubmed/34940516
http://dx.doi.org/10.3390/jcdd8120161
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author Sugimura, Yukiharu
Bauer, Sebastian
Immohr, Moritz Benjamin
Hermsen, Derik Franz
Westenfeld, Ralf
Boeken, Udo
Aubin, Hug
Tudorache, Igor
Lichtenberg, Artur
Akhyari, Payam
author_facet Sugimura, Yukiharu
Bauer, Sebastian
Immohr, Moritz Benjamin
Hermsen, Derik Franz
Westenfeld, Ralf
Boeken, Udo
Aubin, Hug
Tudorache, Igor
Lichtenberg, Artur
Akhyari, Payam
author_sort Sugimura, Yukiharu
collection PubMed
description Despite the critical feature of heparin-induced thrombocytopenia (HIT) for patients on mechanical circulatory support, reports on its incidence and outcome are still scarce. Thus, we report on clinical features of HIT in patients under Impella 5.0 or 5.5 (Abiomed Inc., Danvers, MA, USA) (Impella 5+) support for acute cardiogenic shock (CS) by focusing on observed thrombotic events. Between November 2018 and December 2020, a total of 56 consecutive patients were enrolled in a single-center retrospective study. A total of 21 patients (37.5%) were tested for HIT, and 6 (10.7%) proved positive for HIT at 10.5 ± 2.89 days after the first heparin administration during current admission. Interestingly, thrombocyte counts dropped under Impella support in all groups (all cases, no HIT test, and HIT negative group: p < 0.001, HIT-positive group: p = 0.001). All HIT-positive patients were switched from heparin to argatroban. HIT-associated thrombotic events were observed in two cases resulting in Impella dysfunction due to pump thrombosis (n = 1) and left ventricular (LV) thrombus formation (n = 1). Under large Impella support, the prevalence of HIT was relatively high. Further, thrombocytopenia does not deliver a high specificity in the setting of Impella 5+ support. Considering HIT manifestation, a routine HIT test may be considered to avoid critical thrombotic adverse events.
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spelling pubmed-87093002021-12-25 Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Large Impella for Acute Cardiogenic Shock Sugimura, Yukiharu Bauer, Sebastian Immohr, Moritz Benjamin Hermsen, Derik Franz Westenfeld, Ralf Boeken, Udo Aubin, Hug Tudorache, Igor Lichtenberg, Artur Akhyari, Payam J Cardiovasc Dev Dis Article Despite the critical feature of heparin-induced thrombocytopenia (HIT) for patients on mechanical circulatory support, reports on its incidence and outcome are still scarce. Thus, we report on clinical features of HIT in patients under Impella 5.0 or 5.5 (Abiomed Inc., Danvers, MA, USA) (Impella 5+) support for acute cardiogenic shock (CS) by focusing on observed thrombotic events. Between November 2018 and December 2020, a total of 56 consecutive patients were enrolled in a single-center retrospective study. A total of 21 patients (37.5%) were tested for HIT, and 6 (10.7%) proved positive for HIT at 10.5 ± 2.89 days after the first heparin administration during current admission. Interestingly, thrombocyte counts dropped under Impella support in all groups (all cases, no HIT test, and HIT negative group: p < 0.001, HIT-positive group: p = 0.001). All HIT-positive patients were switched from heparin to argatroban. HIT-associated thrombotic events were observed in two cases resulting in Impella dysfunction due to pump thrombosis (n = 1) and left ventricular (LV) thrombus formation (n = 1). Under large Impella support, the prevalence of HIT was relatively high. Further, thrombocytopenia does not deliver a high specificity in the setting of Impella 5+ support. Considering HIT manifestation, a routine HIT test may be considered to avoid critical thrombotic adverse events. MDPI 2021-11-25 /pmc/articles/PMC8709300/ /pubmed/34940516 http://dx.doi.org/10.3390/jcdd8120161 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sugimura, Yukiharu
Bauer, Sebastian
Immohr, Moritz Benjamin
Hermsen, Derik Franz
Westenfeld, Ralf
Boeken, Udo
Aubin, Hug
Tudorache, Igor
Lichtenberg, Artur
Akhyari, Payam
Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Large Impella for Acute Cardiogenic Shock
title Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Large Impella for Acute Cardiogenic Shock
title_full Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Large Impella for Acute Cardiogenic Shock
title_fullStr Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Large Impella for Acute Cardiogenic Shock
title_full_unstemmed Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Large Impella for Acute Cardiogenic Shock
title_short Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Large Impella for Acute Cardiogenic Shock
title_sort heparin-induced thrombocytopenia under mechanical circulatory support by large impella for acute cardiogenic shock
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8709300/
https://www.ncbi.nlm.nih.gov/pubmed/34940516
http://dx.doi.org/10.3390/jcdd8120161
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