Case 1–2015

Nhieu, Sonia; Nguyen, Liem; Pretorius, Victor; Ovando, Julio; Moore, D.; Banks, Dalia A.; Koster, Andreas; Morshuis, Michiel; Faraoni, David

doi:10.1053/j.jvca.2014.09.009

Cited by 9 publications

(1 citation statement)

References 42 publications

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“…Patients with impaired renal function are at risk of bleeding complications due to significant reduction in plasma clearance of up to 24% [ 8 ]. There are case reports describing prolonged coagulopathy post LVAD implantation in HIT patients using bivalirudin [ 7 , 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

The use of cangrelor with heparin for left ventricular assist device implantation in a patient with acute heparin-induced thrombocytopenia

Gernhofer

Ross

Khoche

et al. 2018

J Cardiothorac Surg

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BackgroundOptimal anticoagulation strategy for cardiopulmonary bypass (CPB) in end-stage heart failure patients with heparin-induced thrombocytopenia (HIT) requiring left ventricular assist device (LVAD) implantation remains uncertain. Presently, there are no large-scale randomized studies comparing outcomes of alternative anticoagulation strategies for CPB in this patient population. A novel antiplatelet agent – cangrelor, which is a potent P2Y12 inhibitor with robust antiplatelet efficacy, rapid reversibility, and measurable drug effect, has become available since 2015. Intraoperative anticoagulation for CPB using cangrelor with heparin has not been reported before.Case presentationWe report the case of a 47-year-old male with ischemic cardiomyopathy and acute HIT, who underwent an urgent LVAD implantation using cangrelor with heparin for anticoagulation on CPB. This novel strategy resulted in satisfactory anticoagulation for CPB without perioperative thromboembolic events or major bleeding requiring reoperation.ConclusionsCangrelor with heparin was an effective anticoagulation strategy for CPB in this critically ill patient with acute HIT requiring an urgent LVAD implantation. Further studies are warranted to evaluate its efficacy and replicability in other patients with acute or subacute HIT who require urgent cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

The use of cangrelor with heparin for left ventricular assist device implantation in a patient with acute heparin-induced thrombocytopenia

Gernhofer

Ross

Khoche

et al. 2018

J Cardiothorac Surg

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High‐dose IVIG plus cangrelor platelet “anesthesia” during urgent heparin‐CPB in a patient with recent SRA‐negative HIT‐thrombosis with persisting platelet‐activating antibodies

Koster

Nazy

Birschmann

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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In a high‐risk patient with subacute heparin‐induced thrombocytopenia (HIT) type A (platelet count recovery following acute HIT but with persisting platelet‐activating antibodies), in whom urgent cardiac surgery was required, a key clinical question arose: could intraoperative heparin be given safely with “platelet anesthesia” provided with high‐dose intravenous immunoglobulin (IVIG) plus cangrelor (ultra‐short‐acting antiplatelet agent)? This approach proved successful, without unexpected postoperative thrombocytopenia or thromboembolism. In vitro studies confirmed that both IVIG and cangrelor contributed to perioperative inhibition of HIT antibody‐induced platelet activation. Interestingly, despite the patient testing strongly positive in 4 HIT immunoassays (latex immunoturbidimetric assay and 3 enzyme‐immunoassays), the serotonin‐release assay (SRA) was consistently negative. Nevertheless, platelet‐activating HIT antibodies were detectable using modified (platelet factor 4–enhanced) SRA. Our protocol of heparin rechallenge following IVIG/cangrelor provides both intraoperative and early postoperative inhibition of HIT antibody‐induced platelet activation and is applicable to patients with circulating functional HIT antibodies requiring urgent heart surgery, including those with “SRA‐negative HIT.”

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Bivalirudin/heparin

2015

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Case 1–2015

Cited by 9 publications

References 42 publications

The use of cangrelor with heparin for left ventricular assist device implantation in a patient with acute heparin-induced thrombocytopenia

The use of cangrelor with heparin for left ventricular assist device implantation in a patient with acute heparin-induced thrombocytopenia

High‐dose IVIG plus cangrelor platelet “anesthesia” during urgent heparin‐CPB in a patient with recent SRA‐negative HIT‐thrombosis with persisting platelet‐activating antibodies

Bivalirudin/heparin

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