Heparin-Induced Thrombocytopenia under Mechanical Circulatory Support by Surgical Microaxial Pump Catheters for Acute Cardiogenic Shock

 

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Background: In recent years, surgical microaxial pump catheters (smaPC) delivering 5 or 5.5 L/minute support have been widely utilized to treat pre- or postoperative heart failure and cardiogenic shock (CS). However, only anecdotal reports have been published despite the critical feature of Heparin-induced thrombocytopenia (HIT) in patients on mechanical circulatory support (MCS) with smaPC. Thus, we report our experience with HIT in patients under smaPC support for acute CS by focusing on observed thrombotic events.

Method: Between November 2018 and December 2020, a total of 56 consecutive patients were treated with smaPC at a single-center. For this study, these patients were assigned to three groups; no HIT test group, HIT positive group and HIT negative group. Further, we analyzed the clinical features of HIT cases by focusing on thrombotic events.

Results: A total of 21 patients (37.5%) were tested for HIT, and six (10.7%) prove positive for HIT at 10.5 ± 2.9 days after the first heparin administration in the current admission. Interestingly, all groups demonstrated dominant thrombocyte drops without statistical differences between groups (all cases, no HIT test, HIT negative group: p < 0.001, HIT positive group: p = 0.001. In HIT-positive patients, argatroban was administrated intravenously as well as supplemented to the purge solution. Thrombocyte counts dramatically improved after the conversion of anticoagulation to argatroban (platelet count (*1,000 μL) at a minimum level during smaPC use versus 2 days after conversion: 32.8 ± 5.56 vs. 82.5 ± 18.6, p = 0.02). HIT-associated thrombotic events were observed in two cases (33.3% in HIT-positive group), resulting in smaPC dysfunction due to pump thrombosis (n = 1) or left ventricular thrombus formation (n = 1).

Conclusion: Under smaPC support, the prevalence of HIT was relatively high (10.7%), with the onset of HIT at 10.5 ± 2.9 days after first heparin exposure during current hospitalization. Furthermore, 33.3% of all HIT patients suffered from critical hypercoagulation events. In our study, thrombocytopenia was not a clear discriminator for diagnosis of HIT in patients with smaPC. High-level awareness regarding the development of HIT is needed to avoid critical thrombotic adverse in patients under smaPC support.

Publication History

Article published online:
03 February 2022

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