Intraoperative management of patients with heparin-induced thrombocytopenia

Kappa, Jeffrey R.; Fisher, Carol A.; Todd, Barbara; Stenach, Nina; Bell, P J; Campbell, Fred; Ellison, Norig; Addonizio, V. Paul

doi:10.1016/0003-4975(90)90008-t

Cited by 78 publications

(25 citation statements)

References 23 publications

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“…It is worth bearing in mind that when used for the complete prevention of platelet aggregation in HIT patients, a much higher dosage of iloprost, of up to 48 ng/kg/min, is required. [21] In both groups in this study, no bleeding complications were observed, suggesting that the administered dosage of iloprost is safe. To prove this assumption, a larger number of patients have to be investigated.…”

Section: Discussionmentioning

confidence: 52%

Iloprost for Additional Anticoagulation in Continuous Renal Replacement Therapy—A Pilot Study

et al. 2007

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Purpose. The aim of this pilot study was to compare the effect of heparin anticoagulation with and without iloprost administration during continuous renal replacement therapy (CRRT) in critically ill patients. Material and methods. In a prospective, randomized, controlled pilot study at an intensive care unit at a university hospital, 20 patients requiring CRRT were investigated. Patients were allocated into two groups: group 1, the heparin group; and group 2, the heparin plus 1 ng/kg/min iloprost. In both groups, activated partial thromboplastin time (aPTT) was adjusted to 40-50 sec. Observation time was a maximum of 7 days. Results. Median filter run time was significantly prolonged by iloprost administration to a median of 14 h (13-26 h) compared to 10 h (4-12 h) in the heparin group (p = 0.004). A decrease in platelet count was attenuated by iloprost administration (p = 0.012). There were no bleeding complications in either group. Hemofiltration efficiency did not differ significantly between the groups. Conclusion. Additional administration of iloprost prolonged the filter run time of continuous veno-venous hemofiltration (CVVH) in this setting and attenuated the fall in platelet count during CRRT.

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Section: Discussionmentioning

confidence: 52%

Iloprost for Additional Anticoagulation in Continuous Renal Replacement Therapy—A Pilot Study

et al. 2007

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“…Olinger et al [15] in 1984 were the first to identify that the use of iloprost could inhibit heparin-dependent platelet activation in the presence of HIT serum. Since then, small studies referring to the UFH's deleterious effects being offset by iloprost administration in patients with HIT requiring cardiac surgery have been published [16][17][18][19][20]36,37]. The major drawback of iloprost is its effect on vasomotor tone, particularly the marked vasodilatation and lifethreatening hypotension that may result.…”

Section: Discussionmentioning

confidence: 99%

Perioperative use of iloprost in cardiac surgery patients diagnosed with heparin‐induced thrombocytopenia‐reactive antibodies or with true HIT (HIT‐reactive antibodies plus thrombocytopenia): An 11‐year experience

et al. 2015

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*Thrombocytopenia and thromboembolism(s) may develop in heparin immune-mediated thrombocytopenia (HIT) patients after reexposure to heparin. At the Onassis Cardiac Surgery Center, 530 out of 17,000 patients requiring heart surgery over an 11-year period underwent preoperative HIT assessment by ELISA and a threepoint heparin-induced platelet aggregation assay (HIPAG). The screening identified 110 patients with HITreactive antibodies, out of which 46 were also thrombocytopenic (true HIT). Cardiac surgery was performed in HIT-positive patients under heparin anticoagulation and iloprost infusion. A control group of 118 HITnegative patients received heparin but no iloprost during surgery. For the first 20 patients, the dose of iloprost diminishing the HIPAG test to 5% was determined prior to surgery by in vitro titration using the patients' own plasma and donor platelets. In parallel, the iloprost "target dose" was also established for each patient intraoperatively, but before heparin administration. Iloprost was infused initially at 3 ng/kg/mL and further adjusted intraoperatively, until ex vivo aggregation reached 5%. As a close correlation was observed between the "target dose" identified before surgery and that established intraoperatively, the remaining 90 patients were administered iloprost starting at the presurgery identified "target dose." This process significantly reduced the number of intraoperative HIPAG reassessments needed to determine the iloprost target dose, and reduced surgical time, while maintaining similar primary clinical outcomes to controls. Therefore, infusion of iloprost throughout surgery, under continuous titration, allows cardiac surgery to be undertaken safely using heparin, while avoiding life-threatening iloprost-induced hypotension in patients diagnosed with HIT-reactive antibodies or true HIT.

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“…Heparin uygulamasına bağlı %2-5 trombositopeni gelişebildiği bildirilmesine rağmen biz çalışma grubunda böyle bir problemle karşılaşmadık (8). Heparin uygulamasına bağlı nadiren trombozis gelişebildiği ve çok ciddi sonuçları olduğu bazı yayınlarda bildirilmiştir (9).…”

Section: Discussionunclassified

Açik Kalp Cerrahi̇si̇nde Anti̇koagülasyonun Sağlanmasinda Hepari̇n-Protami̇n Ti̇trasyonunun Önemi̇

Çorapçıoğlu¹

1997

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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Intraoperative management of patients with heparin-induced thrombocytopenia

Cited by 78 publications

References 23 publications

Iloprost for Additional Anticoagulation in Continuous Renal Replacement Therapy—A Pilot Study

Iloprost for Additional Anticoagulation in Continuous Renal Replacement Therapy—A Pilot Study

Perioperative use of iloprost in cardiac surgery patients diagnosed with heparin‐induced thrombocytopenia‐reactive antibodies or with true HIT (HIT‐reactive antibodies plus thrombocytopenia): An 11‐year experience

Açik Kalp Cerrahi̇si̇nde Anti̇koagülasyonun Sağlanmasinda Hepari̇n-Protami̇n Ti̇trasyonunun Önemi̇

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