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Management of anticoagulation in patients with subacute heparin-induced thrombocytopenia scheduled for heart transplantation.
- Source :
-
Blood [Blood] 2008 Nov 15; Vol. 112 (10), pp. 4024-7. Date of Electronic Publication: 2008 Sep 12. - Publication Year :
- 2008
-
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.
- Subjects :
- Adult
Arginine analogs & derivatives
Autoantibodies blood
Autoantibodies immunology
Heart Failure blood
Heart Failure immunology
Heparin immunology
Hirudins administration & dosage
Humans
Male
Middle Aged
Pipecolic Acids administration & dosage
Platelet Factor 4 immunology
Recombinant Proteins administration & dosage
Sulfonamides
Thrombocytopenia immunology
Anticoagulants administration & dosage
Anticoagulants adverse effects
Heart Failure surgery
Heart Transplantation immunology
Heparin administration & dosage
Heparin adverse effects
Thrombocytopenia blood
Thrombocytopenia chemically induced
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0020
- Volume :
- 112
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 18791163
- Full Text :
- https://doi.org/10.1182/blood-2008-03-145243