Patency of coronary artery bypass grafts in patients with heparin-induced thrombocytopenia

Liu, Jayson C.; Lewis, Bruce E.; Steen, Lowell; Grassman, Eric D.; Bakhos, Mamdouh; Blakeman, Bradford; Wrona, L; Leya, Ferdinand

doi:10.1016/s0002-9149(02)02252-x

Cited by 41 publications

(20 citation statements)

References 8 publications

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“…In a small retrospective study, Liu et al found that patients who develop HIT-induced myocardial ischemia after CABG have a higher incidence of safenous vein graft occlusions when compared with patients without HIT. In contrast, the frequency of occlusion of internal mammary grafts was not significantly different in patients with or without HIT [18]. It is unclear why saphenous vein grafts may be more prone to heparin-induced thrombosis than mammary artery grafts.…”

Section: Discussionmentioning

confidence: 87%

Heparin‐induced thrombocytopenia presenting with thrombosis of multiple saphenous vein grafts and myocardial infarction

et al. 2004

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Section: Discussionmentioning

confidence: 87%

Heparin‐induced thrombocytopenia presenting with thrombosis of multiple saphenous vein grafts and myocardial infarction

et al. 2004

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“…48 After coronary artery bypass grafting, the occlusion rate for saphenous vein grafts, but not arterial conduits, is significantly increased in HIT patients compared with non-HIT controls. 49 Arterial thrombosis more frequently occurs than venous thrombosis in HIT patients receiving heparin for cardiovascular disease. 50 HIT patients may also experience disseminated intravascular coagulation.…”

Section: Clinical Features and Natural Historymentioning

confidence: 99%

When Heparins Promote Thrombosis

2005

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“…96 In cardiac surgery patients developing HIT, arterial is more frequent than venous thrombosis (mainly lower limb arteries). 98,104 Saphenous vein graft occlusion is a prominent manifestation of HIT 105 since it is present in 38% to 81% of the cases with an associated mortality of 28%. 98,99 Deep vein thrombosis (especially associated with central venous catheters) and pulmonary embolism are also common.…”

Section: Management Of Heparin-induced Thrombocytopenia (Hit)mentioning

confidence: 99%

Antithrombotic therapy in cardiac surgery

Vincentelli

Jude

Bélisle

2006

Can J Anesth/J Can Anesth

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Purpose: To review the perioperative management of antithrombotic therapy in cardiac surgery, including the management of cardiopulmonary bypass (CPB) and off-pump surgery.Methods: A review of the relevant English literature over the period was undertaken, in addition to a review of international practices in antithrombotic therapy in cardiac surgery. Principal findings:Cardiopulmonary bypass is required in most procedures and makes anticoagulation mandatory. Anticoagulation is, usually, achieved with unfractionnated heparin (UFH). Unfractionated heparin is monitored by point-ofcare (POC) testing, such as the activated clotting time or the determination of heparin concentration. The target values of both tests remain empirical, with no clearly validated thresholds. The target value needs to be adjusted according to the POC test, given significant variations between devices and activators. After CABG, the need for antiplatelet therapy is well demonstrated, in order to limit the risk of postoperative death or ischemic events, and improve venous graft patency. Immediately after valvular surgery, antithrombotic therapy should take into account the specific risk carried by each patient and by each prosthetic device. The risk of venous thromboembolism, though poorly defined, is also present in the postoperative period and may require additional attention. Given the frequent exposure to UFH, occurrence of heparininduced thrombocytopenia is not infrequent in these patients and requires careful individual management. Conclusions:Antithrombotic therapy is an essential component of cardiac surgery. Yet, with the exception of antiplatelet agents in CABG patients, antithrombotic therapy is often based on the clinical experience of medical teams more than on an evidence-based assessment of the literature. Objectif Constatations principales : La circulation extracorporelle est nécessaire pour la majorité des opérations et rend l'anticoagulation obligatoire. L'anticoagulation est, habituellement, réalisée avec de l'héparine non fractionnée (HNF). L'HNF est contrôlée par des tests faits au chevet du malade comme le temps de coagulation activée ou la détermination de la concentration d'héparine. Les valeurs cible des deux tests demeurent empiriques, sans valeurs seuil clairement validées. La valeur cible doit être ajustée en fonction de chaque test de chevet à cause des variations significatives entre les instruments et les activateurs. Après le pontage aortocoronarien (PAC), la nécessité d'un traitement antiplaquettaire a été bien démontrée, qui vise à limiter les décès postopératoires ou les incidents ischémiques et à améliorer la

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Patency of coronary artery bypass grafts in patients with heparin-induced thrombocytopenia

Cited by 41 publications

References 8 publications

Heparin‐induced thrombocytopenia presenting with thrombosis of multiple saphenous vein grafts and myocardial infarction

Heparin‐induced thrombocytopenia presenting with thrombosis of multiple saphenous vein grafts and myocardial infarction

When Heparins Promote Thrombosis

Antithrombotic therapy in cardiac surgery

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