We have read with great interest the paper "Characterization of hospitalized cardiovascular patients with suspected heparin-induced thrombocytopenia" by Stoll and co-workers [1] and we found it very important with a view to clinical prevention

Farinetti A.

Manenti A

Mattioli AV

English

Archivio istituzionale della ricerca - Università di Modena e Reggio Emilia

L E T T E R TO TH E ED I TO RBacteremia in cardiac surgery patients with heparin-inducedthrombocytopeniaTo the Editor,We have read with great interest the paper “Characterization of hos-pitalized cardiovascular patients with suspected heparin-inducedthrombocytopenia” by Stoll et al1 and we found it very important witha view to clinical prevention.The authors investigated if the 4T score, a validated score forprediction of heparin-induced thrombocytopenia (HIT) in surgicalpatients, is also suitable for assessing HIT probability in cardiovascu-lar patients with unclear thrombocytopenia. They found that the 4Tscore had a sensitivity of 82.6% and a specificity of 28.6% in theirpatients, suggesting that it might not sufficiently predict the clinicalprobability of HIT in cardiovascular patients. They also found thatbacteremia was more frequent in patients with non-confirmed HIT,suggesting infection as a frequent differential diagnosis of thrombo-cytopenia in these patients (49% vs 17%, P = 0.0185).With reference to the finding reported in the paper, wewould like to make the following contribution to the discussion.We retrospectively analyzed data from 600 post-cardiac surgerypatients in order to evaluate the incremental value of performing4Ts Test and EuroSCORE test for prediction of heparin-inducedthrombocytopenia.2 Anti-PF4/heparin antibodies were tested inall patients using a commercial immunoassay (Asserachrom H PF4ELISA kits).3–5 Of the 600 patients investigated, 131 (21.8%)were found to have anti-PF4/heparin antibodies in the post-operative period (5-7 days from surgery). The 4Ts score identifiedhigh probability patients that developed anti-PF4/heparin anti-bodies and had a high number of thrombotic events.2 Among theseveral parameters analyzed bacteremia was similar in the twogroups (P = n.s.) and was not associated with an increased risk ofcomposite cardiovascular events (MACE).We understand that our post-cardiac surgery patients carry highrisk for bacteremia and this could influence our results.3–6We agree with Stoll that further research is needed to specifythe risk profile for HIT in different group of cardiovascularpatients.Informed consent was obtained from all individual participantsincluded in the study.CONFLICTS OF INTERESTThe authors declare no potential conflict of interests.ORCIDAnna Vittoria Mattioli https://orcid.org/0000-0003-1487-9530Anna Vittoria MattioliAntonio ManentiAlberto FarinettiDepartment of Surgical, Medical and Dental Department ofMorphological Sciences related to Transplant Oncology and RegenerativeMedicine, University of Modena and Reggio Emilia, Modena, ItalyCorrespondenceProf Anna Vittoria Mattioli, MD, PhD, Department of Surgical, Medicaland Dental Department of Morphological Sciences related to Transplant,Oncology and Regenerative Medicine, University of Modena and ReggioEmilia, Via del pozzo, 71 41100 Modena, Italy.Email: annavittoria.mattioli@unimore.itThis letter is related to Stoll F, Gödde M, Leo A, Katus HA, MüllerOJ. Characterization of hospitalized cardiovascular patients withsuspected heparin-induced thrombocytopenia. Clin Cardiol. 2018; doi:10.1002/clc.23061 [Epub ahead of print].REFERENCES1. Stoll F, Gödde M, Leo A, Katus HA, Müller OJ. Characterization of hos-pitalized cardiovascular patients with suspected heparin-inducedthrombocytopenia. Clin Cardiol. 2018;41(12):1521-1526. https://doi.org/10.1002/clc.23061.2. Mattioli AV, Manenti A, Farinetti A. 4Ts score and EuroSCORE in car-diac surgery. J Thromb Thrombolysis. 2017;45:291-292. https://doi.org/10.1007/s11239-017-1604-z.3. Husseinzadeh HD, Gimotty PA, Pishko AM, Buckley M, Warkentin TE,Cuker A. Heparin-induced thrombocytopenia in contemporary cardiacsurgical practice and experience with a protocol for early identification.Am J Cardiol. 2016;117(2):305-309. https://doi.org/10.1016/j.amjcard.2015.10.047.4. Mattioli AV, Bonetti L, Carletti U, Ambrosio G, Mattioli G. Thromboticevents in patients with antiplatelet factor 4/heparin antibodies. Heart.2009;95(16):1350-1354. https://doi.org/10.1136/hrt.2008.160549.5. Mattioli AV. Prevalence of anti-PF4/heparin antibodies and the HITsyndrome in cardiovascular medicine. Semin Thromb Hemost. 2004;30(3):291-295.6. Mattioli AV, Bonetti L, Zennaro M, Ambrosio G, Mattioli G. Hepar-in/PF4 antibodies formation after heparin treatment: temporal aspectsand long-term follow-up. Am Heart J. 2009;157(3):589-595. https://doi.org/10.1016/j.ahj.2008.11.007.Received: 2 September 2018 Accepted: 6 September 2018DOI: 10.1002/clc.23081Clinical Cardiology. 2018;41:1527. wileyonlinelibrary.com/journal/clc © 2018 Wiley Periodicals, Inc. 1527

Bacteremia in Cardiac Surgery Patients with Heparin-Induced Thrombocytopenia

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Bacteremia in Cardiac Surgery Patients with Heparin-Induced Thrombocytopenia

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