Purpose
Heparin‐induced thrombocytopenia (HIT) presents a unique challenge in patients requiring orthotopic heart transplantation (OHT). We sought to pool the existing evidence in a systematic review.
Methods
Electronic search was performed to identify all relevant studies on OHT in patients with HIT. Patient‐level data for 33 patients from 21 studies were extracted for statistical analysis.
Results
Median patient age was 51 [IQR 41, 55] years, with 75.8% (25/33) males. All patients had a clinical diagnosis of HIT, and anti‐PF4/Heparin antibodies were positive in 87.9% (29/33). Median lowest reported platelet count was 46 × 109/L [27.2, 73.5]. Intraoperatively, 61% (20/33) of patients were given unfractionated heparin (UFH), while 39% (13/33) were given alternative anticoagulants. The alternative agent subgroup required more antifibrinolytics [54% (7/13) vs 10% (2/20), P = .02] and clotting factors [69.2% (9/13) vs 15.0% (3/20), P < .01]. Perioperative thrombosis occurred more [53.8% (7/13) vs 0% (0/20, P < .01) in alternate agent subgroup. More patients in the alternate agent subgroup required post‐operative transfusions [54% (7/13) vs 0% (0/20), P < .01]. Thirty‐day mortality of 15.2% (5/33) was comparable between the subgroups.
Conclusion
Heparin use during OHT may be associated with less adverse effects compared to use of other anticoagulants with no difference in 30‐day mortality.