Heparin Antibodies and the side effects

[Moonie]

My dad recently had a quadruple bypass. The day after the surgery he seemed to be doing ok. Later that nite things went bad. Several days, and tests later the doctors found he had developed antibodies to the Heparin given to him during the surgery. They discoverd this also after scaring us to death telling us he may have TTP. He's basically been in a coma like state for over a week now. He may lose some toes, which is actually an improvement. He's had numerous dialysis treatments, he can't breathe right on his own. Well there are just many problems, some things are now getting better but he has such a long way to go and they dont know if he will ever fully recover, physically and mentally. My question is, shouldn't the doctors of tested him for that before surgery? They knew he had heparin before, they knew there was a chance he could have developed an allergy or antibodies to it. It was explained to me that it is uncommon for someone to have a bad reaction to this so they don't test for it. I know they have to give it for the surgery but they could have had things set up to give him directly after the surgery to prevent such a bad reaction. They told me they do that if they know before hand someone has an allergy or antibodies related to heparin. All his symptoms were similar to TTP, and so they at first assumed that must be what was wrong with him, instead of going with the obvious that he was having a reaction to the heparin. So basically I'm just very angry and confused. Can you shed any light on this situation? THANKS!!

[CCF-M.D.-RCJ]

Moonie,

Thanks for the post.  Sorry to read of your father's ordeal.

I certainly understand your anger with your father's situation, but the reality is that HIT (heparin-induced thrombocytopenia) is a rare complication of heparin therapy.  No hospital in this country tests for antibodies to heparin prior to bypass surgery -- and with good reason.  The presence of the antibodies is a poor predictor of whether or not someone will develop HIT.  The test is only helpful for supporting the clinical diagnosis of HIT.

When I say that HIT is a clinical diagnosis, I mean that the diagnosis can only be made in the setting of the right signs and symptoms, not by a lab test.  The lab tests help confirm a clinicain's diagnosis.

If the heparin antibodies had been detected prior to the surgery, the most likely scenario would have been that the doctors would have used a different anti-coagulant for the bypass.  But using a different anti-coagulant is frequently complicated by excess bleeding or clotting due to poor standards for how to use these other anti-coagulants.

Again, I'm sorry for your family's tragedy, but the reality is that the occurence was just a really bad, awful break.

[Moonie]

Thank You for your quick response. I appreciate your honesty with this situation. I'm just angry because it seems to me this could have been avoided if they had only tested him before hand. But I see that it really would not have been helpful. Then I'm also botherd by the fact that they new there was a risk he could have a bad reaction and when he did, they didn't even think it could be due to something they gave him, it HAD to be that he had TTP. It was over a week before they determined it was not TTP and it was in fact a bad reaction to the heparin.  Well it's just a bad situation that seems to just keep gettin worse. Again, I appreciate your quick response.

[letitbe]

For recent and very helpful, clear information on this subject (HIT) look up articles by John Frances PHD. Best wishes.