How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass
Heparin-induced thrombocytopenia (HIT) is a major issue in cardiac surgery requiring cardiopulmonary bypass (CPB). HIT represents a severe adverse drug reaction after heparin administration. It consists of immune-mediated thrombocytopenia paradoxically leading to thrombotic events. Detection of anti...
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| Format: | Article |
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MDPI AG
2023-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/3/786 |
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| author | Etienne Revelly Emmanuelle Scala Lorenzo Rosner Valentina Rancati Ziyad Gunga Matthias Kirsch Zied Ltaief Marco Rusca Xavier Bechtold Lorenzo Alberio Carlo Marcucci |
| author_facet | Etienne Revelly Emmanuelle Scala Lorenzo Rosner Valentina Rancati Ziyad Gunga Matthias Kirsch Zied Ltaief Marco Rusca Xavier Bechtold Lorenzo Alberio Carlo Marcucci |
| author_sort | Etienne Revelly |
| collection | DOAJ |
| description | Heparin-induced thrombocytopenia (HIT) is a major issue in cardiac surgery requiring cardiopulmonary bypass (CPB). HIT represents a severe adverse drug reaction after heparin administration. It consists of immune-mediated thrombocytopenia paradoxically leading to thrombotic events. Detection of antibodies against platelets factor 4/heparin (anti-PF4/H) and aggregation of platelets in the presence of heparin in functional in vitro tests confirm the diagnosis. Patients suffering from HIT and requiring cardiac surgery are at high risk of lethal complications and present specific challenges. Four distinct phases are described in the usual HIT timeline, and the anticoagulation strategy chosen for CPB depends on the phase in which the patient is categorized. In this sense, we developed an institutional protocol covering each phase. It consisted of the use of a non-heparin anticoagulant such as bivalirudin, or the association of unfractionated heparin (UFH) with a potent antiplatelet drug such as tirofiban or cangrelor. Temporary reduction of anti-PF4 with intravenous immunoglobulins (IvIg) has recently been described as a complementary strategy. In this article, we briefly described the pathophysiology of HIT and focused on the various strategies that can be applied to safely manage CPB in these patients. |
| first_indexed | 2024-03-11T09:38:53Z |
| format | Article |
| id | doaj.art-5de5621a469e4e55acaf9c321e82cb66 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T09:38:53Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-5de5621a469e4e55acaf9c321e82cb662023-11-16T17:07:10ZengMDPI AGJournal of Clinical Medicine2077-03832023-01-0112378610.3390/jcm12030786How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary BypassEtienne Revelly0Emmanuelle Scala1Lorenzo Rosner2Valentina Rancati3Ziyad Gunga4Matthias Kirsch5Zied Ltaief6Marco Rusca7Xavier Bechtold8Lorenzo Alberio9Carlo Marcucci10Department of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandDepartment of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandDepartment of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandDepartment of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandDepartment of Cardiac Surgery, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandFaculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011 Lausanne, SwitzerlandDepartment of Intensive Care Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandDepartment of Intensive Care Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandDepartment of Cardiac Surgery, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandFaculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 1011 Lausanne, SwitzerlandDepartment of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, SwitzerlandHeparin-induced thrombocytopenia (HIT) is a major issue in cardiac surgery requiring cardiopulmonary bypass (CPB). HIT represents a severe adverse drug reaction after heparin administration. It consists of immune-mediated thrombocytopenia paradoxically leading to thrombotic events. Detection of antibodies against platelets factor 4/heparin (anti-PF4/H) and aggregation of platelets in the presence of heparin in functional in vitro tests confirm the diagnosis. Patients suffering from HIT and requiring cardiac surgery are at high risk of lethal complications and present specific challenges. Four distinct phases are described in the usual HIT timeline, and the anticoagulation strategy chosen for CPB depends on the phase in which the patient is categorized. In this sense, we developed an institutional protocol covering each phase. It consisted of the use of a non-heparin anticoagulant such as bivalirudin, or the association of unfractionated heparin (UFH) with a potent antiplatelet drug such as tirofiban or cangrelor. Temporary reduction of anti-PF4 with intravenous immunoglobulins (IvIg) has recently been described as a complementary strategy. In this article, we briefly described the pathophysiology of HIT and focused on the various strategies that can be applied to safely manage CPB in these patients.https://www.mdpi.com/2077-0383/12/3/786cardiac surgerycardiopulmonary bypassintraoperative managementheparin-induced thrombocytopenia syndromedirect thrombin inhibitorantiplatelet therapy |
| spellingShingle | Etienne Revelly Emmanuelle Scala Lorenzo Rosner Valentina Rancati Ziyad Gunga Matthias Kirsch Zied Ltaief Marco Rusca Xavier Bechtold Lorenzo Alberio Carlo Marcucci How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass Journal of Clinical Medicine cardiac surgery cardiopulmonary bypass intraoperative management heparin-induced thrombocytopenia syndrome direct thrombin inhibitor antiplatelet therapy |
| title | How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass |
| title_full | How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass |
| title_fullStr | How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass |
| title_full_unstemmed | How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass |
| title_short | How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass |
| title_sort | how to solve the conundrum of heparin induced thrombocytopenia during cardiopulmonary bypass |
| topic | cardiac surgery cardiopulmonary bypass intraoperative management heparin-induced thrombocytopenia syndrome direct thrombin inhibitor antiplatelet therapy |
| url | https://www.mdpi.com/2077-0383/12/3/786 |
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