Outcomes With Heparin-Induced Thrombocytopenia After Cardiac Surgery

Brown, James A.; Aranda‐Michel, Edgar; Kilic, Arman; Serna‐Gallegos, Derek; Bianco, Valentino; Thoma, Floyd; Navid, Forozan; Sultan, Ibrahim

doi:10.1016/j.athoracsur.2020.10.046

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…Treatment of HIT includes cessation of heparin therapy and initiation of a non-heparin anticoagulant. 1 – 3 ) Our patient met all the HIT criteria and eventually was diagnosed with HIT; however, the diagnosis was delayed. Retrospectively, we should have been more careful because of the DVT and subsequent PE, despite administering standard DVT prophylaxis.…”

Section: Discussionmentioning

confidence: 78%

“…5,6) Usually, patients diagnosed with HIT after heparin exposure tend to show high morbidity and mortality rates after cardiac surgery. 3) Although cardiovascular surgery in patients with a history of HIT or HIT secondary to cardiovascular surgery is described in the literature, [1][2][3]7) few studies have reported surgical thrombectomy in a patient with HIT. Campisi et al reported a case of thrombectomy of a giant left ventricular thrombus associated with HIT under heparinization for CPB.…”

Section: Discussionmentioning

confidence: 99%

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Cardiopulmonary Bypass Surgery in a Patient with Unexpected Heparin-Induced Thrombocytopenia

Miyagawa

Yuri

Nakano

et al. 2022

Annals of Vascular Diseases

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We report a case of a 77-year-old woman with massive pulmonary embolism associated with heparin-induced thrombocytopenia. Before developing a pulmonary embolism, the patient underwent gastrectomy due to gastric cancer and received subcutaneous heparin calcium for deep venous thrombosis prophylaxis for 5 d. Then, thrombectomy with cardiopulmonary bypass using full heparinization was successfully performed. The patient was definitively diagnosed with this condition postoperatively, based on elevated serum antibody levels, in addition to pre-and postoperative thrombocytopenia and thrombosis. Intravenous heparin therapy was switched to argatroban. Although it is uncommon, clinicians should consider this condition in patients with a history of heparin exposure.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Bypass Surgery in a Patient with Unexpected Heparin-Induced Thrombocytopenia

Miyagawa

Yuri

Nakano

et al. 2022

Annals of Vascular Diseases

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“…Concerns around this technique may be warranted when considering data presented by Brown et al, that showed mortality after cardiac surgery was significantly higher in patients who developed HIT. 67 Interestingly, mortality was not different among those patients with HIT with thrombotic events and those without.…”

Section: Updates On Transfusion Studies In Cardiac Surgerymentioning

confidence: 92%

Coagulation and Transfusion Updates From 2021

Fabbro

Patel

Henderson

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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“…While some degree of thrombocytopenia is common following cardiac surgery, a diagnosis of HIT can be devastating. 4 In addition, the hypercoagulable state of HIT places patients with a mechanical support device at elevated risk for pump thrombosis. Per our facility's protocol, heparin products are discontinued after an observed fall of more than 50% from baseline or total platelet count less than 100 × 10 9 /L, and immediate labs are sent for PF4 absorbance and SRA.…”

Section: Commentarymentioning

confidence: 99%

“…As demonstrated with this patient, postcardiotomy thrombocytopenia complicates the management of anticoagulation. While some degree of thrombocytopenia is common following cardiac surgery, a diagnosis of HIT can be devastating 4 . In addition, the hypercoagulable state of HIT places patients with a mechanical support device at elevated risk for pump thrombosis.…”

Section: Commentarymentioning

confidence: 99%

Use of a novel bicarbonate‐based Impella 5.5 purge solution in a coagulopathic patient

Simonsen¹,

Gunn

Malhotra³

et al. 2021

Journal of Cardiac Surgery

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The Impella 5.5 with Smart Assist (Abiomed) is a life-saving treatment option in acute heart failure which utilizes a continuous heparin purge solution to prevent thrombosis. In patients with contraindications to heparin, alternative anticoagulation strategies are required. We describe the stepwise management of anticoagulation in a coagulopathic patient with persistent cardiogenic shock following a coronary artery bypass procedure who underwent Impella 5.5 placement. A direct thrombin inhibitor-based purge solution was utilized while evaluating for heparin-induced thrombocytopenia. The use of a novel bicarbonate-based purge solution (BBPS) was successfully used due to severe coagulopathy. There were no episodes of pump thrombosis or episodes of severe bleeding on the BBPS and systemic effects of alkalosis and hypernatremia were minimal.

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Outcomes With Heparin-Induced Thrombocytopenia After Cardiac Surgery

Cited by 15 publications

References 23 publications

Cardiopulmonary Bypass Surgery in a Patient with Unexpected Heparin-Induced Thrombocytopenia

Cardiopulmonary Bypass Surgery in a Patient with Unexpected Heparin-Induced Thrombocytopenia

Coagulation and Transfusion Updates From 2021

Use of a novel bicarbonate‐based Impella 5.5 purge solution in a coagulopathic patient

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