Management of anticoagulation in patients with subacute heparin-induced thrombocytopenia scheduled for heart transplantation

Blood. 2008 Nov 15;112(10):4024-7. doi: 10.1182/blood-2008-03-145243. Epub 2008 Sep 12.

Abstract

Anticoagulation management of patients with recent heparin-induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB) surgery is a serious challenge, and especially difficult in patients requiring urgent heart transplantation. As nonheparin anticoagulants during CPB bear a high risk of major bleeding, these patients are at risk of being taken off the transplant list. Short-term use of unfractionated heparin (UFH) for CPB, with restriction of UFH to the surgery itself, is safe and effective in patients with a history of HIT who test negative for antiplatelet factor 4 (PF4)/heparin antibodies. We present evidence that it is safe to expand the concept of UFH reexposure to patients with subacute HIT (ie, those patients with recent HIT in whom the platelet count has recovered but in whom anti-PF4/heparin IgG antibodies remain detectable) requiring heart transplantation, if they test negative by a sensitive functional assay using washed platelets. This can be lifesaving in patients with end-stage heart failure.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects*
  • Arginine / analogs & derivatives
  • Autoantibodies / blood
  • Autoantibodies / immunology
  • Heart Failure / blood
  • Heart Failure / immunology
  • Heart Failure / surgery*
  • Heart Transplantation* / immunology
  • Heparin / administration & dosage*
  • Heparin / adverse effects*
  • Heparin / immunology
  • Hirudins / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Pipecolic Acids / administration & dosage
  • Platelet Factor 4 / immunology
  • Recombinant Proteins / administration & dosage
  • Sulfonamides
  • Thrombocytopenia / blood*
  • Thrombocytopenia / chemically induced*
  • Thrombocytopenia / immunology

Substances

  • Anticoagulants
  • Autoantibodies
  • Hirudins
  • Pipecolic Acids
  • Recombinant Proteins
  • Sulfonamides
  • Platelet Factor 4
  • Heparin
  • Arginine
  • argatroban
  • lepirudin