Cardiac Surgery and Heparin Induced Thrombocytopaenia (HIT): A Case Report and Short Review

McMeniman, W. J.; Chard, R.; Norrie, John; Posen, Jennifer S

doi:10.1016/j.hlc.2012.02.005

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…Limitations for bivalirudin use include possible excessive bleeding due to lack of antidote, prolonged effect with renal dysfunction, and difficulty in monitoring. 2 Our patient's hematologic history complicated the choice of anticoagulant for CPB. He had a remarkably high risk for thromboembolic complications given his history of primary APS and remote HIT.…”

Section: Discussionmentioning

confidence: 98%

“…HIT is a potentially life-threatening complication of heparin administration that occurs in approximately 1% to 5% of exposures, although antibody formation is far more common. 2 HIT may occur if platelet-activating IgG antibodies recognize PF4 in complex with heparin and subsequently trigger the most prothrombotic release of thrombin we know to date. Thrombocytopenia occurs as a result of increased platelet turnover.…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate administration is achieved by adding a minimum of 20 to 50 mg to the priming solution of the CPB circuit, followed by a loading dose of 0.75 to 1.25 mg/kg immediately prior to aortic cannulation. An infusion of 1.75 to 2.75 mg/kg/h 2,18 is administered for the duration of bypass. In our case, we elected to use the maximum dose, 1.25 mg/kg bolus followed by a 2 to 3 mg/kg/h infusion, due to the patient's remarkably high risk for thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Antibodies may be present in nearly 50% of all CPB patients within 1 week after their first surgery. [1][2][3][4][5] HIT is an acquired disorder characterized by antibodymediated platelet activation resulting in thrombocytopenia and severe thromboembolic events. HIT and other hematologic conditions add additional challenges to the management of anticoagulation for CPB.…”

Section: Introductionmentioning

confidence: 99%

“…Antibodies may be present in nearly 50% of all CPB patients within 1 week after their first surgery. 1-5…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Warsame

Nakia

Stephen

et al. 2018

Semin Cardiothorac Vasc Anesth

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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.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Antibodies may be present in nearly 50% of all CPB patients within 1 week after their first surgery. 1-5…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Warsame

Nakia

Stephen

et al. 2018

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

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Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue

Schwartz

Winters

Padmanabhan

et al. 2013

J of Clinical Apheresis

562

769

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The American Society for Apheresis (ASFA) JCA Special Issue Writing Committee is charged with reviewing, updating and categorizating indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Sixth Edition of the ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by consistently applying the category and GRADE system definitions, but eliminating the "level of evidence" criteria (from the University HealthCare Consortium) utilized in prior editions given redundancy between GRADE and University HealthCare Consortium systems. The general layout and concept of a fact sheet that was utilized in the Fourth and Fifth Editions, has been largely maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. This article consists of 78 fact sheets (increased from 2010) for therapeutic indications in ASFA categories I through IV, with many diseases categorized having multiple clinical presentations/situations which are individually graded and categorized.

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Guidelines on the Use of Therapeutic Apheresis in Clinical Practice–Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue

Schwartz

Padmanabhan

Aqui

et al. 2016

J of Clinical Apheresis

601

1,181

View full text Add to dashboard Cite

The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.

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Cardiac Surgery and Heparin Induced Thrombocytopaenia (HIT): A Case Report and Short Review

Cited by 8 publications

References 24 publications

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

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

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice–Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue

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