scholarly journals Heparin-induced thrombocytopenia and cardiopulmonary bypass: anticoagulation with unfractionated heparin and the GPIIb/IIIa inhibitor tirofiban and successful use of rFVIIa for post-protamine bleeding due to persistent platelet blockade

2008 ◽  
Vol 34 (3) ◽  
pp. 687-689 ◽  
Author(s):  
Marion Durand ◽  
Thomas Lecompte ◽  
Marie Hacquard ◽  
Jean-Pierre Carteaux
Keyword(s):  
Cardiopulmonary Bypass ◽  
Unfractionated Heparin ◽  
Heparin Induced Thrombocytopenia

Prevalence of Heparin-Dependent Platelet Antibodies in Children after Cardiopulmonary Bypass Surgery.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3019-3019
Author(s):  
Rowena C. Punzalan ◽  
Sheila J. Hanson ◽  
Nancy Ghanayem ◽  
Brian R. Curtis ◽  
Kathleen Murkowski ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Unfractionated Heparin ◽  
Pediatric Intensive Care ◽  
Serotonin Release ◽  
Platelet Factor 4 ◽  
Enzyme Linked Immunosorbent Assay ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Platelet Antibodies ◽  
Release Assay

Abstract Heparin is used during cardiopulmonary bypass (CPB) surgery in children. Upon exposure to heparin, heparin-dependent platelet antibodies (HDPA) may form against complexes of platelet factor 4 and heparin on platelet surfaces. Heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia and thrombosis (HITT) may then ensue. Among adult CPB patients, up to 50% demonstrate HDPA, although only 2% develop HIT and 1% develop HITT. In previous studies done among non-CPB newborns and pediatric intensive care patients, the incidence of HDPA has been zero to minimal. Objective: To determine prevalence of HDPA among children undergoing CPB who are exposed to unfractionated heparin for >120 hours after CPB. Methods: We designed a prospective pilot study. All patients ≤ 12 years old who were to receive heparin during CPB were eligible. The presence of HDPA was assessed by heparin-platelet factor 4 enzyme-linked immunosorbent assay (ELISA); positive and equivocal results were confirmed by serotonin release assay. Blood samples were obtained at the time of cessation of heparin or after 10 days on heparin, whichever came first. Results: Thirty patients were enrolled: 15 were aged 2–19 days (median 6 days); 15 were aged 1.2 to 50 months (median 4.5 months). One patient had borderline positive and 1 had positive results by heparin-platelet factor 4 ELISA; both had negative results by serotonin release assay; neither developed clots. Eighteen patients developed thrombocytopenia, which is common after CPB, including the 2 with equivocal results by ELISA. Six patients, all with negative ELISAs, developed symptomatic thromboses. Conclusion: There were no HDPA identified among children who received unfractionated heparin for CPB. The specificity of heparin-platelet factor 4 ELISA among children should be assessed.

A Patient With Remote Heparin-Induced Thrombocytopenia and Antiphospholipid Syndrome Requiring Cardiopulmonary Bypass: Do Current Guidelines Apply?

2018 ◽  
Vol 23 (2) ◽  
pp. 256-260 ◽  
Author(s):  
Warsame Ibrahim ◽  
Hunter Nakia ◽  
Miller Stephen ◽  
Spiess Bruce ◽  
Whitson Bryan ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Unfractionated Heparin ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Artery Bypass ◽  
Inhibitory Effect ◽  
Heparin Induced Thrombocytopenia ◽  
History Of ◽  
Complex Decision Making

Anticoagulation for cardiopulmonary bypass (CPB) is required to prevent acute disseminated intravascular coagulation and clot formation within the bypass circuit. Unfractionated heparin is the standard anticoagulant for CPB due to its many advantages and long history of successful use. However, heparin has the unique drawback of triggering Heparin-PF4 (PF4) antibodies potentially leading to heparin-induced thrombocytopenia (HIT). We have limited data regarding reformation of antibodies if a patient has had a prior (remote) antibody production or full HIT. Patients with antiphospholipid antibodies undergoing CPB with unfractionated heparin have a high complication rate, even in the absence of HIT. Antiphospholipid antibodies have a multifaceted, cumulatively inhibitory effect on the normal anticoagulation armamentarium in vivo. Even more concerning is the possibility that antiphospholipid syndrome and HIT may be synergistic. We report a patient with risk factors for both thromboembolic (remote history of HIT and antiphospholipid syndrome) and hemorrhagic complications who underwent an aortic valve replacement and coronary artery bypass grafting on CPB using bivalirudin. We discuss the complex decision making regarding anticoagulant for CPB, particularly with regard to American College of Chest Physicians guidelines.

scholarly journals Pharmacokinetic/pharmacodynamic model for unfractionated heparin dosing during cardiopulmonary bypass

2017 ◽  
Vol 118 (5) ◽  
pp. 705-712 ◽  
Author(s):  
X. Delavenne ◽  
E. Ollier ◽  
S. Chollet ◽  
F. Sandri ◽  
J. Lanoiselée ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Unfractionated Heparin ◽  
Pharmacodynamic Model

Heparin-induced thrombocytopenia and cardiopulmonary bypass: perioperative argatroban use

2003 ◽  
Vol 75 (2) ◽  
pp. 577-579 ◽  
Author(s):  
Norbert Lubenow ◽  
Sixten Selleng ◽  
Hans-Georg Wollert ◽  
Petra Eichler ◽  
Bernd Müllejans ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Heparin Induced Thrombocytopenia

scholarly journals P1510INCIDENCE AND OUTCOME HEMODIALYSIS PATIENCE WITH HEPARIN INDUCED THROMBOCYTOPENIA - FOUR YEAR EXPERIENCE ZVEZDARA UNIVERSITY MEDICAL CENTER

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ana Bulatovic ◽  
Vesna Maslarevic Radovic ◽  
Katarina Markovic ◽  
Petar Djuric ◽  
Jelena Tosic Dragovic ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Medical Center ◽  
Hemodialysis Patients ◽  
Elisa Test ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Administration ◽  
Alternative Anticoagulation ◽  
Patients At Risk ◽  
Clinical Scoring

Abstract Background and Aims Heparin-induced thrombocytopenia (HIT) is a potentially fatal adverse reaction after administration of unfractionated or fractionated heparin, which underlies the generation of antibodies to the heparin complex and platelet factor 4 (PF4). It occurs in 5% of patients treated with unfractionated heparin and 0.5 - 1.5% fractionated heparin. The aim of the study is to determine the incidence and outcome of hemodialysis patients with HIT over 4 years period. Method Our retrospective study analyzed patients who were tested for evidence of positive anti-heparin antibody in the period from 2015 to 2019 in Zvezdara University Medical Center. The diagnosis was confirmed by the 4T clinical scoring system, a positive antiheparin-PF4 ELISA test and a positive platelet aggregation test with heparin. Results During observation period, total of 54 tests were performed on HIT suspected patients, out of which 21 patients were positive. Out of them, 14 patients were on HD, and other 7 (geriatric, surgery and cardiology departments) received therapy due to peripheral thrombosis, AIM or arrhythmia. All patients treated at nephrology, started hemodialysis (HD) with unfractionated heparin, while others were treated with LMWH. 4T scoring showed that 64% of patients had a moderate risk of developing HIT, while high risk was assessed in 36% of patients. Thrombotic complications in the form of deep venous thrombosis had 50% of patients, pulmonary thromboembolism had 11% of patients. The greatest decrease in Tr was most commonly observed between 10th and 14th day (61% of patients) and 39% from 4th to 10th day from start of heparin administration. In addition to heparin withdrawal and treatment with alternative nonheparin anticoagulation (fondaparinoux), 5 patients needed plasma treatment. 11 patients on HD were transferred to peritoneal dialysis (PD), and 2 patients recovered renal function. Overall mortality was 52%, while in nephrology patients was below 30%. Conclusion HIT should be considered in patients at risk. It is necessary to abolish heparin treatment and use alternative method (PD) or alternative anticoagulation. Hemodialysis patients have better prognosis than other comparable patients.

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