Clinical Experiences of Heart Transplantation in Patients With Heparin-induced Thrombocytopenia
10.3969/j.issn.1000-3614.2025.04.004
- VernacularTitle:肝素诱导的血小板减少症患者的心脏移植初步探索
- Author:
Chunlei FENG
1
;
Sheng LIU
;
Jie HUANG
;
Zhongkai LIAO
;
Shanshan ZHENG
;
Zhe ZHENG
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 心力衰竭和移植病房,北京 100037
- Publication Type:Journal Article
- Keywords:
heart transplantation;
heparin-induced thrombocytopenia;
intra-aortic balloon pump;
cardiopulmonary bypass
- From:
Chinese Circulation Journal
2025;40(4):340-345
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:When heparin-induced thrombocytopenia(HIT)is diagnosed before heart transplantation,recommendation varies according to small sample observations from other countries.In China,recent HIT is considered as a relative contradiction for heart transplantation and clinical study results is not yet available.Methods:A total of 325 patients who received heart transplantation in Fuwai Hospital from January 1,2022 to July 31,2024 were retrospectively analyzed,124 of whom received instrumental circulation and heparin before transplantation,and 15 of whom had suspected HIT before surgery.Diagnostic strategy was based on clinical investigation,antibody detection and expert opinion.Results:All 15 patients used intra-aortic balloon pump(IABP)preoperatively,6 were diagnosed with HIT,contributing 4.8%of those who used mechanical circulation support before heart transplantation.Three patients were tested positive for HIT-Ab just before surgery.Three different anticoagulation strategies:bivalirudin,heparin,and combined bivalirudin and heparin was used in each of the 3 patients,respectively.Their clinical features varied significantly.The first patient experienced challenging bleeding issue and cervical vein embolization.The second patient experienced low-limb embolization and the third patient experienced spleen artery embolization.Thrombocyte count returned to normal range at day 8,6 and 10 respectively post operation.Conclusions:HIT is not rare in patients using IABP and other mechanical circulation support devices before heart transplantation.Diagnosis and treatment of HIT is challenging for patients awaiting heart transplantation.
