Heparin-coated catheters and heparin-induced thrombocytopenia

Ten patients with heparin-coated pulmonary artery catheters had heparin-induced thrombocytopenia, which persisted after all other sources of heparin were discontinued. The thrombocytopenia occurred in approximately 0.4% of the patients receiving heparin-coated catheters and remitted when the catheters were removed. The platelet counts averaged 59,000/mm3 at the time of the diagnosis and recovered to an average of 143,000/mm3 by 3 days (range 2 to 4 days) after removal of the heparin-coated catheters. One patient required a second catheter 31 days after the first catheter had been removed. When the second heparin-coated catheter was inserted, the platelet count decreased from 307,000/mm3 to 102,000/mm3 in 4 days. Segments of heparin-coated pulmonary artery catheters were placed in platelet-rich plasma and incubated with serum from patients with known heparin-associated antiplatelet antibodies or with serum from volunteers with no exposure to heparin. The heparin-coated catheters induced platelet aggregation in all samples containing serum from patients with heparin-induced thrombocytopenia. However, platelet aggregation did not occur when the catheters were incubated with the serum of the volunteers. Non-heparin-coated catheters failed to produce platelet aggregation when incubated with either sera. The high mortality and morbidity rates associated with heparin-induced thrombocytopenia mandate that afflicted patients receive no more heparin, at least until the heparin-associated antiplatelet antibodies are no longer detectable. Patients with heparin-coated catheters who have thrombocytopenia should be tested for the presence of heparin-associated antiplatelet antibodies. If heparin-induced thrombocytopenia is confirmed, the catheters must be removed if the thrombocytopenia is to be reversed and complication avoided.