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PEDIATRICS Vol. 109 No. 1 January 2002, pp. e10

ELECTRONIC ARTICLE

Heparin-Induced Thrombocytopenia-Associated Thrombosis in Pediatric Intensive Care Patients

Markus Schmugge, MD*, Lorenz Risch, MD{ddagger},§, Andreas R. Huber, MD§, Anne Benn, MD|| and Joachim E. Fischer, MD, MSc||,¶

* Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
{ddagger} Department of Clinical Immunology, University Hospital Zurich, Switzerland
§ Department of Laboratory Medicine, Kantonsspital, Aarau, Switzerland
|| Department of Neonatology and Pediatric Intensive Care, University-Children’s Hospital, Zurich, Switzerland
Horten-Zentrum for Evidence Based Research and Knowledge Transfer, University Hospital, Zurich, Switzerland

--> Background. Heparin-induced thrombocytopenia (HIT), a well-known side effect of heparin therapy, occurs in 1% to 5% of adults exposed to heparin. Of those, about 29% to 88% develop thrombosis. Most data on HIT-associated thrombosis in children are confined to anecdotal reports.

Objective. To determine the incidence of HIT-associated thrombosis in heparin-exposed children.

Methods. We performed a retrospective cohort study on all patients admitted to our pediatric intensive care unit between August 1996 and January 1999. Patients who received heparin for >=5 days were eligible. Within these patients, we identified all cases of radiologically confirmed thrombosis. Cases of thrombosis were reviewed for fulfillment of clinical HIT criteria. HIT-associated thrombosis was confirmed serologically by determination of levels of antibodies against heparin/platelet factor 4 complexes.

Results. Of 1950 children admitted during the study period, 612 were exposed to heparin for >=5 days. Thrombosis occurred in 57 patients (9.3%). Plasma samples were available for 38 cases, of which 14 satisfied clinical HIT-criteria. Calculated incidence rate for HIT-associated thrombosis: 2.3%, (95% confidence interval: 1.3%–3.9%, for patients exposed to heparin >=5 days). Nine patients suffered from venous, 2 patients from arterial, and 3 had combined arterial and venous thrombosis. None of the 14 patients died or underwent amputation. Six patients had heparin and platelet factor 4-complex antibody levels above the cutoff level for adults. The remaining 8 patients had significantly higher antibody levels than a matched control group.

Conclusion. Compared with that reported for adults, HIT-associated thrombosis in pediatric intensive care unit patients has a similar incidence but a less severe outcome.

Key Words: heparin-induced thrombocytopenia • children • neonates • thrombosis

Abbreviations: HIT, heparin-induced thrombocytopenia • HPF4 heparin/platelet factor 4 • PICU, pediatric intensive care unit • ELISA, enzyme-linked immunosorbent assay

Received for publication Feb 5, 2001; Accepted Aug 13, 2001.




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