FATAL THROMBOCYTOPENIC COAGULOPATHY AFTER CARDIOPULMONARY BYPASS - CLINICOPATHOLOGICAL CORRELATIONS IMPLICATING HEPARIN

Heparin-associated thrombotic thrombocytopenia after cardiopulmonary b ypass is frequently lethal. The propensity for this syndrome generally goes unrecognized because thrombocytopenia is common in the early pos toperative period and because testing for heparin-induced platelet ant ibody may not distinguish between patients with thrombocytopenia alone and those in whom associated thrombi (the white clot syndrome) may de velop. Moreover, differentiation between heparin-associated thrombotic thrombocytopenia and a consumptive coagulopathy may be difficult, and intervention may be inappropriate because of diametrically opposite t reatments. Our experience with three cases and the necropsy findings i n two of them demonstrate that postbypass thrombocytopenic coagulopath y may be a clinical and pathologic spectrum of consumptive coagulopath y, with heparin as the major premorbid factor. This report further emp hasizes the need for vigilance in assessing certain patients preoperat ively to lessen the high risk of morbidity and mortality associated wi th this syndrome.