HEPARIN-INDUCED THROMBOCYTOPENIA - EXPERIENCES IN 12 HEART-SURGERY PATIENTS

A heparin induced thrombocytopenia Type II (HIT) is a dangerous compli cation of heparin therapy. Bleeding, but above all serious thromboembo lic complications, which may result in crippling disabilities or even death, can develop. Twelve heart surgery patients who were diagnosed w ith a HIT Type II are reported. Seven of the patients were diagnosed p ost operatively, the other five pre-operatively. Two of these patients underwent heart surgery with r-Hirudin (Behringwerke AC, Marburg, Ger many) on cardiopulmonary bypass and two on Orgaran (AKZO Organon, the Netherlands). Of the seven post operative HIT patients, four had had a bypass operation and each had received a mitral or aortic valve repla cement. Another patient had received an artificial biventricular suppo rt system (Berlin Heart) and was diagnosed with HIT Type II post opera tively. Because of his special condition, this patient underwent antic oagulation with Orgaran and heart transplantation with Orgaran on a he art lung machine. Upon suspicion of HIT Type II, heparin therapy was i mmediately halted and an alternative treatment of Orgaran or r-Hirudin was begun. One patient encountered bleeding of a gastric ulcer on Org aran therapy. Heart surgery patients, especially patients with an arti ficial support system, are potentially lethally threatened by serious thromboembolic complications accompanying HIT Type II. Therefore, thes e patients must be diagnosed as early as possible. Orgaran along with r-Hirudin are effective heparin substitutes in patients with HIT Type II. These medications can be widely administered to heart surgery pati ents pre-, intra-, and post operatively without complication.