تقرير
أعرض في EDS

Heparin-induced thrombocytopenia in lower extremity free tissue transfers.

التفاصيل البيبلوغرافية
العنوان: Heparin-induced thrombocytopenia in lower extremity free tissue transfers.
المؤلفون: McMains CJ; Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Mather TL; Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Adamson KA; Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Whitfield R; Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Doren EL; Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Hettinger PC; Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA., LoGiudice JA; Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
المصدر: Microsurgery [Microsurgery] 2024 Jan; Vol. 44 (1), pp. e31075. Date of Electronic Publication: 2023 Jun 20.
نوع المنشور: Case Reports
اللغة: English
بيانات الدورية: Publisher: Wiley-Liss Country of Publication: United States NLM ID: 8309230 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-2752 (Electronic) Linking ISSN: 07381085 NLM ISO Abbreviation: Microsurgery Subsets: MEDLINE
أسماء مطبوعة: Publication: Hoboken, NJ : Wiley-Liss
Original Publication: New York : Alan R. Liss, [c1983-
مواضيع طبية MeSH: Thrombocytopenia*/chemically induced , Thrombocytopenia*/complications , Thrombocytopenia*/diagnosis , Thrombosis*/etiology , Thrombosis*/surgery , Free Tissue Flaps*, Humans ; Anticoagulants/adverse effects ; Heparin/adverse effects ; Lower Extremity/surgery ; Retrospective Studies
مستخلص: Background: Heparin-induced thrombocytopenia (HIT) an immunologically mediated reaction to heparin products, can lead to severe thrombocytopenia and potentially life-threatening thrombotic events. In microsurgery, a missed or delayed diagnosis of HIT can cause complications requiring revision operations, flap loss, or limb loss. Surgeons must remain vigilant for this uncommon yet potentially devastating condition and keep abreast of management strategies.
Methods: CPT and ICD-10 codes in electronic medical records were used to collect demographic information, clinical courses, and outcomes for patients with a HIT diagnosis who underwent lower extremity free tissue transfer in one institution.
Results: The authors' institution performed 415 lower extremity free flaps in 411 patients during the 10-year study period. Flap salvage rate was 71% for compromised lower extremity flaps without HIT, and 25% in those with HIT. Four patients (four flaps) met study inclusion criteria during the study period. Three of the four flaps failed and were later debrided; one was rescued after a takeback for anastomosis revision. Two patients successfully underwent a delayed second free flap procedure after recovery, and one was salvaged with a pedicled muscle flap.
Conclusions: Surgeons should monitor for HIT by establishing coagulation panel and platelet count baselines and trending these values in the early post-operative period for patients treated with heparin products. The 4T score can be used to screen for HIT with high clinical suspicion. Arterial thrombosis or poor flap perfusion despite sound microvascular technique could suggest HIT. Surgical and medical management including strict heparin avoidance can prevent adverse events for these patients.
(© 2023 Wiley Periodicals LLC.)
References: Barlow, A., Barlow, B., Reinaker, T., & Harris, J. (2019). Potential Role of Direct Oral Anticoagulants in the Management of Heparin-induced Thrombocytopenia. Pharmacotherapy, 39, 837-853.
Berry, C., Tcherniantchouk, O., Ley, E. J., Salim, A., Mirocha, J., Martin-Stone, S., Stolpner, D., & Margulies, D. R. (2011). Overdiagnosis of heparin-induced thrombocytopenia in surgical ICU patients. Journal of the American College of Surgeons, 213, 10-17 discussion 17-8.
Bloemen, A., Testroote, M. J. G., Janssen-Heijnen, M. L. G., & Janzing, H. M. J. (2012). Incidence and diagnosis of heparin-induced thrombocytopenia (HIT) in patients with traumatic injuries treated with unfractioned or low-molecular-weight heparin: A literature review. Injury, 43, 548-552.
Busch, K. H., Knobloch, K., & Vogt, P. M. (2009). Evidence for a locally limited form of heparin-induced thrombocytopenia in plastic reconstructive surgery? Plastic and Reconstructive Surgery, 124, 277e-278e. https://doi.org/10.1097/PRS.0b013e3181b98f14.
Dang, C. H., Durkalski, V. L., & Nappi, J. M. (2006). Evaluation of treatment with direct thrombin inhibitors in patients with heparin-induced thrombocytopenia. Pharmacotherapy, 26, 461-468.
Greinacher, A. (2015). Clinical Practice. Heparin-Induced Thrombocytopenia. The New England Journal of Medicine, 373, 252-261.
Linkins, L. A. (2015). Heparin induced thrombocytopenia. BMJ, 350, 1-11.
Lo, G. K., Juhl, D., Warkentin, T. E., Sigouin, C. S., Eichler, P., & Greinacher, A. (2006). Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. Journal of Thrombosis and Haemostasis, 4, 759-765.
Macias, D., Kwon, D. I., Walker, P. C., & Peterson, N. R. (2017). Local intraluminal irrigation with argatroban during free flap repair in a patient with heparin-induced thrombocytopenia. The Annals of Otology, Rhinology, and Laryngology, 126, 407-410.
Martel, N., Lee, J., & Wells, P. S. (2005). Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: A meta-analysis. Blood, 106, 2710-2715.
Nand, S., Wong, W., Yuen, B., Yetter, A., Schmulbach, E., & Gross, F. S. (1997). Heparin-induced thrombocytopenia with thrombosis: Incidence, analysis of risk factors, and clinical outcomes in 108 consecutive patients treated at a single institution. American Journal of Hematology, 56, 12-16.
Schleich, A. R., Oswald, T. M., & Lineaweaver, W. C. (2008). Complete salvage of impending free flap failure in heparin induced thrombocytopenia by emergent institution of therapy with argatroban. Journal of Plastic, Reconstructive & Aesthetic Surgery, 61, 1263-1264. https://doi.org/10.1016/j.bjps.2008.01.028.
Stimac, G., Walters, E. T., Elmarsafi, T., Attinger, C., & Evans, K. K. (2018). Incidence of heparin-induced thrombocytopenia in lower-extremity free flap reconstruction correlates with the overall surgical population. Journal of Plastic, Reconstructive & Aesthetic Surgery, 71, 1252-1259.
Tessler, O., Vorstenbosch, J., Jones, D., Lalonde, S., & Zadeh, T. (2014). Heparin-induced thrombocytopenia and thrombosis as an under-diagnosed cause of flap failure in heparin-naive patients: A case report and systematic review of the literature. Microsurgery, 34, 157-163. https://doi.org/10.1002/micr.22190.
Tremblay, D. M., Harris, P. G., Gagnon, A. R., Cordoba, C., Brutus, J. P., & Nikolis, A. (2008). Heparin-induced thrombocytopenia syndrome as a cause of flap failure: A report of two cases. Journal of Plastic, Reconstructive & Aesthetic Surgery, 61, 78-83.
Warkentin, T. E., & Heddle, N. M. (2003). Laboratory diagnosis of immune heparin-induced thrombocytopenia. Current Hematology Reports, 2, 148-157.
المشرفين على المادة: 0 (Anticoagulants)
9005-49-6 (Heparin)
تواريخ الأحداث: Date Created: 20230620 Date Completed: 20240131 Latest Revision: 20240131
رمز التحديث: 20240131
DOI: 10.1002/micr.31075
PMID: 37339917
قاعدة البيانات: MEDLINE
الوصف
تدمد:1098-2752
DOI:10.1002/micr.31075