According to a study published in the Journal of Surgical Oncology, heparin‐induced thrombocytopenia and thrombosis (HITT) was associated with a high re‐exploration rate of vascularized lymph node transplantations (VLNTs) in patients with primary lymphedema.

The researchers conducted a retrospective study investigating the outcomes of HITT in patients with primary lymphedema who underwent VLNT at a single center between 2012 and 2019. They categorized patients into HITT and non-HITT groups and compared outcomes between the groups.

Of 41 patients, there were 26 patients with 31 VLNTs in the HITT group (median age, 47 years; interquartile range [IQR], 21-55.7) and 15 patients with 16 VLNTs in the non‐HITT group (28 years; IQR, 14-38.8; P =.05). For lymphatic severity, the mean Taiwan lymphedema stage was 4 in the HITT group and 3 in the non‐HITT group (P =.01). No other significant differences in patient demographics or disease characteristics were observed between the groups.

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The researchers found significantly higher first, second, and third re‐exploration rates in the HITT group (38.7%, 25.7%, and 6.5%) than the non‐HITT group (6.3%, 0%, and 0%, respectively; P =.01 for all). The HITT group showed a significantly greater decrease in platelet count compared with the non‐HITT group (mean decrease, 21% vs 14%) on postoperative Day 1 (P <.01). The cutoff value of the percentage of the platelet reduction on postoperative Day 1 was 17% with an area under the receiver operating characteristic curve of 0.88.

“HITT may cause a high re‐exploration rate of VLNTs in primary lymphedema patients,” the investigators wrote. “The 17% reduction in platelets on postoperative day one was an early sign for detecting HITT.”


Hsu SY, Lin CY, Cheng MH. Heparin-induced thrombocytopenia and thrombosis in primary lymphedema patients who underwent vascularized lymph node transplantations. J Surg Oncol. Published online February 2, 2022. doi:10.1002/jso.26811