Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Heparin-induced Thrombocytopenia Type II after Free Flap Operation

  • Baek, Jiwoong (Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry) ;
  • Park, Jung Hyun (Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry) ;
  • Cha, In-Ho (Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry) ;
  • Kim, Hyung Jun (Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry)
  • Received : 2013.08.09
  • Accepted : 2013.11.26
  • Published : 2013.11.30
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Abstract

After radical excision of a tumor in the maxillofacial area, functional and esthetic reconstruction is needed, including flap surgery. Among the many etiologies of flap failure, venous thrombosis is one of the most frequent. Heparin is used routinely in the effort to avoid development of venous thrombosis. In rare cases, heparin-induced thrombocytopenia (HIT) type II occurs due to exposure to heparin. Heparin attached to platelet factor 4 forms a PF4/heparin-immunoglobulin G immune complex on platelet surfaces. This complex activates platelets, which leads to multiple coagulation in venous and arterial blood. We report here on a rare occurrence of HIT type II following fibula free flap surgery.

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References

  1. Warkentin TE, Roberts RS, Hirsh J, Kelton JG. An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients. Arch Intern Med 2003;163: 2518-24. https://doi.org/10.1001/archinte.163.20.2518
  2. Tremblay DM, Harris PG, Gagnon AR, Cordoba C, Brutus JP, Nikolis A. Heparin-induced thrombocytopenia syndrome as a cause of flap failure: a report of two cases. J Plast Reconstr Aesthet Surg 2008;61:78-83. https://doi.org/10.1016/j.bjps.2006.12.007
  3. Laster J, Silver D. Heparin-coated catheters and heparin-induced thrombocytopenia. J Vasc Surg 1988;7:667-72.
  4. Warkentin TE, Aird WC, Rand JH. Platelet-endothelial interactions: sepsis, HIT, and antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program 2003:497-519.
  5. Spinler SA, Dager W. Overview of heparin-induced thrombocytopenia. Am J Health Syst Pharm 2003;60 Suppl 5:S5-11.
  6. Linkins LA, Dans AL, Moores LK, et al.; American College of Chest Physicians. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:e495S-530S.
  7. Jeon JH, Park SW, Jo SH, Park JY, Lee JH, Choi SW. Analysis of outcome and complications in 164 cases of free flap reconstructions: experience of a National Cancer Center. J Korean Assoc Maxillofac Plast Reconstr Surg 2011;33:478-82.
  8. Smythe MA, Koerber JM, Mattson JC. The incidence of recognized heparin-induced thrombocytopenia in a large, tertiary care teaching hospital. Chest 2007;131:1644-9. https://doi.org/10.1378/chest.06-2109
  9. Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular- weight heparin or unfractionated heparin. N Engl J Med 1995;332:1330-5. https://doi.org/10.1056/NEJM199505183322003
  10. Warkentin TE. Heparin-induced thrombocytopenia in critically ill patients. Crit Care Clin 2011;27:805-23, v. https://doi.org/10.1016/j.ccc.2011.08.001
  11. Warkentin TE. How I diagnose and manage HIT. Hematology Am Soc Hematol Educ Program 2011;2011:143-9. https://doi.org/10.1182/asheducation-2011.1.143
  12. Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 2006;4:759-65. https://doi.org/10.1111/j.1538-7836.2006.01787.x
  13. DeBois WJ, Liu J, Lee LY, et al. Diagnosis and treatment of heparin-induced thrombocytopenia. Perfusion 2003;18:47-53.