Use of Recombinant Hirudin in Patients with Heparin-induced Thrombocytopenia with Thrombosis Requiring Cardiopulmonary Bypass

Latham, Paige; Revelis, Andreas F.; Joshi, Girish P.; DiMaio, J. Michael; Jessen, Michael E.

doi:10.1097/00000542-200001000-00040

Cited by 31 publications

(17 citation statements)

References 4 publications

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“…If danaparoid sodium or lepirudin is to be used, the frequent monitoring of the anticoagulant should be carefully coordinated among the consulting services. 28 Several reports describe the successful use of danaparoid sodium in the cardiopulmonary bypass setting. In some instances, bleeding has been excessive; however, this can be reduced by administering doses that maintain the antifactor Xa level at 0.7 to 1.5 U/mL and by using hemostatic agents such as fibrin sealant at the sternotomy site.…”

Section: An Approach To Hit In Coronary Artery Bypass Surgerymentioning

confidence: 99%

“…29 Lepirudin is also now being used in selected patients in the cardiopulmonary bypass setting. 18,28,[30][31][32] The whole blood level of lepirudin required for adequate anticoagulation during bypass surgery appears to be 3 to 4 g/mL throughout the procedure. 18,28 This higher value is in contrast to the plasma levels of approximately 0.6 g/mL which are effective in patients with deep venous thrombosis.…”

Section: An Approach To Hit In Coronary Artery Bypass Surgerymentioning

confidence: 99%

“…18,28,[30][31][32] The whole blood level of lepirudin required for adequate anticoagulation during bypass surgery appears to be 3 to 4 g/mL throughout the procedure. 18,28 This higher value is in contrast to the plasma levels of approximately 0.6 g/mL which are effective in patients with deep venous thrombosis. 33 Because the high level required for cardiopulmonary bypass surgery cannot be accurately measured by the activated clotting time or aPTT, the ecarin clotting time has been developed and used successfully.…”

Section: An Approach To Hit In Coronary Artery Bypass Surgerymentioning

confidence: 99%

“…33 Because the high level required for cardiopulmonary bypass surgery cannot be accurately measured by the activated clotting time or aPTT, the ecarin clotting time has been developed and used successfully. 18,28 …”

Section: An Approach To Hit In Coronary Artery Bypass Surgerymentioning

confidence: 99%

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How I treat heparin-induced thrombocytopenia and thrombosis

Alving

2003

Blood

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Section: An Approach To Hit In Coronary Artery Bypass Surgerymentioning

confidence: 99%

Section: An Approach To Hit In Coronary Artery Bypass Surgerymentioning

confidence: 99%

Section: An Approach To Hit In Coronary Artery Bypass Surgerymentioning

confidence: 99%

Section: An Approach To Hit In Coronary Artery Bypass Surgerymentioning

confidence: 99%

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How I treat heparin-induced thrombocytopenia and thrombosis

Alving

2003

Blood

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“…If the need for surgery emerges in a patient with HIT II, danaparoid or lepirudin must be administered with frequent perioperative monitoring of the anticoagulant activity. Such a proceeding should be carefully coordinated among the specialties involved (32).…”

Section: Management Of Acute Hit II In Particular Clinical Settingsmentioning

confidence: 99%

Laboratory Diagnosis of Heparin-Induced Thrombocytopenia and Monitoring of Alternative Anticoagulants

Leo

Winteroll

2003

Clin Vaccine Immunol

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The major complication in the therapeutic or prophylactic use of heparin in medical treatment is type II heparin-induced thrombocytopenia (HIT II), a unique form of drug-induced immune-mediated thrombocytopenia. Due to the extensive use of heparin, this side effect is widespread; up to 3% of patients treated with unfractionated heparin (UFH) develop HIT II (69). Clinically, HIT II is characterized by thrombocytopenia which paradoxically is associated with thrombosis (HIT IIinduced thrombosis [HITTS]) (i.e., deep vein thrombosis, pulmonary embolism, and venous gangrene) in about 50% of the cases.In the pathogenesis of HIT II, the formation of platelet factor 4 (PF4)/heparin complexes seems to be the major determinant (2, 3, 20). The binding of PF4 to heparin induces antibody production directed against a neoepitope created by the three-dimensional assembly of PF4 and heparin. Subsequently, PF4/heparin-antibody complexes induce platelet activation, followed by the shedding of platelet microparticles, thrombin generation, and the involvement of endothelial cells (Fig. 1).Remarkably, the incidence of HIT II, HIT II-associated thrombotic complications, and PF4/heparin-antibodies (HIT II antibodies) in patients receiving therapy with UFH is clearly dependent on the clinical setting of the patient. Cardiosurgical patients are at a high risk to develop HIT II antibodies, while orthopedic patients undergoing hip replacement have a high risk for developing thromboembolic complications (Iceberg model [66]). In medical patients the risk for developing HIT II is substantially lower. Comparing low-molecular-weight heparins (LMWH) with UFH, the use of LMWH coincides with a substantially lower risk of HIT II, but this effect holds true only within the same group of patients (77,78).It is generally accepted that the clinical diagnosis of HIT II should be followed by immediate cessation of heparin therapy and initiation of therapy with alternative anticoagulants. Negative results in the concomitant laboratory testing should not serve as the sole criterion for restarting heparin therapy.In almost every case of HIT II, administration of alternative anticoagulants is essential either to continue prophylactic anticoagulation or to treat and prevent thrombotic complications due to HIT II. Three substances (danaparoid, hirudin, and argatroban) are available. Since these substances have not been compared directly with each other in the treatment of HIT II, criteria such as half-life and/or route of excretion should be considered for selection. This review focuses on (i) the present laboratory methods for diagnosing HIT II, including their principles, time consumption, and significance, and (ii) the alternative anticoagulants, including their characteristics and indications in certain clinical settings. LABORATORY ASSAYS FOR HIT II DIAGNOSISLaboratory testing in the diagnosis of HIT II is based on either the immunological detection of antibodies directed against the PF4/heparin complex or the functional plateletactivating potential of t...

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Hemostasis and Coagulation

Jacobs¹,

Towne²

2005

Vascular Surgery

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Use of Recombinant Hirudin in Patients with Heparin-induced Thrombocytopenia with Thrombosis Requiring Cardiopulmonary Bypass

Cited by 31 publications

References 4 publications

How I treat heparin-induced thrombocytopenia and thrombosis

How I treat heparin-induced thrombocytopenia and thrombosis

Laboratory Diagnosis of Heparin-Induced Thrombocytopenia and Monitoring of Alternative Anticoagulants

Hemostasis and Coagulation

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