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Patency of coronary artery bypass grafts in patients with heparin-induced thrombocytopenia

      Heparin is administered to virtually all patients undergoing cardiopulmonary bypass. The complications of heparin include heparin-induced thrombocytopenia (HIT), which occurs in approximately 1% of patients undergoing coronary artery bypass grafting (CABG).
      • Singer R.L.
      • Mannion J.D.
      • Bauer T.L.
      • Armenti F.R.
      • Edie R.N.
      Complications from heparin-induced thrombocytopenia in patients undergoing cardiopulmonary bypass.
      ,
      • Walls J.T.
      • Curtis J.J.
      • Silver D.
      • Boley T.M.
      • Schmaltz R.A.
      • Nawarawong W.
      Heparin-induced thrombocytopenia in open heart surgical patients sequelae of late recognition.
      Current evidence suggests that HIT is mediated by antibodies that react with heparin and platelet factor 4. The heparin, platelet factor 4, and antibodies form immune complexes, which activate platelets and the coagulation cascade, resulting in a hypercoagulable state.
      • Chong B.H.
      Heparin-induced thrombocytopenia.
      This can result in the development of arterial and venous thrombosis at multiple sites.
      • Singer R.L.
      • Mannion J.D.
      • Bauer T.L.
      • Armenti F.R.
      • Edie R.N.
      Complications from heparin-induced thrombocytopenia in patients undergoing cardiopulmonary bypass.
      ,
      • Walls J.T.
      • Curtis J.J.
      • Silver D.
      • Boley T.M.
      • Schmaltz R.A.
      • Nawarawong W.
      Heparin-induced thrombocytopenia in open heart surgical patients sequelae of late recognition.
      ,
      • Chong B.H.
      Heparin-induced thrombocytopenia.
      The reported incidence of venous and arterial thrombosis in HIT ranges from 39% to 53%.
      • Warkentin T.E.
      Heparin-induced thrombocytopenia a ten-year retrospective.
      ,
      • Wallis D.E.
      • Workman D.L.
      • Lewis B.E.
      • Steen L.
      • Pifarre R.
      • Moran J.F.
      Failure of early heparin cessation as treatment for heparin-induced thrombocytopenia.
      Internal mammary and saphenous vein (SV) graft occlusion rates in the setting of HIT are unknown. In this study, the graft patency of post-CABG patients with HIT was assessed and compared with graft patency of non-HIT post-CABG patients.
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