GTH 2021 State of the Art—Cardiac Surgery: The Perioperative Management of Heparin-Induced Thrombocytopenia in Cardiac Surgery

Abstract

Heparin-induced thrombocytopenia (HIT) is a severe, immune-mediated, adverse drug reaction that paradoxically induces a prothrombotic state. Particularly in the setting of cardiac surgery, where full anticoagulation is required during cardiopulmonary bypass, the management of HIT can be highly challenging, and requires a multidisciplinary approach. In this short review, the different perioperative strategies to run cardiopulmonary bypass will be summarized.

Keywords

Heparin-induced thrombocytopenia - cardiac surgery - state of the art

Publikationsverlauf

Eingereicht: 01. November 2020

Angenommen: 13. Dezember 2020

Artikel online veröffentlicht:
15. Februar 2021

• References

• 1 Staibano P, Arnold DM, Bowdish DM, Nazy I. The unique immunological features of heparin-induced thrombocytopenia. Br J Haematol 2017; 177 (02) 198-207
• 2 Warkentin TE. The paradox of heparin-induced thrombocytopenia. J Thromb Haemost 2009; 7 (09) 1472-1473
• 3 Greinacher A. Clinical practice. Heparin-induced thrombocytopenia. N Engl J Med 2015; 373 (03) 252-261
• 4 Warkentin TE, Sheppard JA, Horsewood P, Simpson PJ, Moore JC, Kelton JG. Impact of the patient population on the risk for heparin-induced thrombocytopenia. Blood 2000; 96 (05) 1703-1708
• 5 Warkentin TE. Laboratory diagnosis of heparin-induced thrombocytopenia. Int J Lab Hematol 2019; 41 (Suppl. 01) 15-25
• 6 Linkins LA, Dans AL, Moores LK. et al. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e495S-e530S
• 7 Cuker A, Arepally GM, Chong BH. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv 2018; 2 (22) 3360-3392
• 8 Pishko AM, Cuker A. Heparin-induced thrombocytopenia in cardiac surgery patients. Semin Thromb Hemost 2017; 43 (07) 691-698
• 9 Veale JJ, McCarthy HM, Palmer G, Dyke CM. Use of bivalirudin as an anticoagulant during cardiopulmonary bypass. J Extra Corpor Technol 2005; 37 (03) 296-302
• 10 Koster A, Dyke CM, Aldea G. et al. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the CHOOSE-ON trial. Ann Thorac Surg 2007; 83 (02) 572-577
• 11 Choxi AA, Patel PA, Augoustides JG. et al. Bivalirudin for cardiopulmonary bypass in the setting of heparin-induced thrombocytopenia and combined heart and kidney transplantation-diagnostic and therapeutic challenges. J Cardiothorac Vasc Anesth 2017; 31 (01) 354-364
• 12 de Prada Martín B, Gualis Cardona J, Pérez Blanco I, Martínez Comendador JM. Fulminant coagulopathy after bivalirudin use in a patient diagnosed with heparin-induced thrombocytopenia and subject to cardiac bypass surgery [in Spanish]. Rev Esp Anestesiol Reanim 2014; 61 (03) 157-161
• 13 Hassen K, Maccaroni MR, Sabry H, Mukherjee S, Serumadar S, Birdi I. Management of refractory bleeding post-cardiopulmonary bypass in an acute heparin-induced thrombocytopenia type II renal failure patient who underwent urgent cardiac surgery with bivalirudin (Angiox^®) anticoagulation. Perfusion 2018; 33 (03) 235-240
• 14 Gatt P, Galea SA, Busuttil W, Grima C, Muscat J, Farrugia Y. Bivalirudin as an alternative anticoagulant for cardiopulmonary bypass during adult cardiac surgery - a change in practice. J Extra Corpor Technol 2017; 49 (01) 49-53
• 15 Nikolaidis N, Velissaris T, Ohri SK. Bivalirudin anticoagulation for cardiopulmonary bypass: an unusual case. Tex Heart Inst J 2007; 34 (01) 115-118
• 16 Koster A, Buz S, Krabatsch T, Yeter R, Hetzer R. Bivalirudin anticoagulation during cardiac surgery: a single-center experience in 141 patients. Perfusion 2009; 24 (01) 7-11
• 17 Koster A, Faraoni D, Levy JH. Argatroban and bivalirudin for perioperative anticoagulation in cardiac surgery. Anesthesiology 2018; 128 (02) 390-400
• 18 Hillebrand J, Sindermann J, Schmidt C, Mesters R, Martens S, Scherer M. Implantation of left ventricular assist devices under extracorporeal life support in patients with heparin-induced thrombocytopenia. J Artif Organs 2015; 18 (04) 291-299
• 19 Martin ME, Kloecker GH, Laber DA. Argatroban for anticoagulation during cardiac surgery. Eur J Haematol 2007; 78 (02) 161-166
• 20 Tanigawa Y, Yamada T, Matsumoto K, Nakagawachi A, Torikai A, Sakaguchi Y. Non-recovery of ACT in a patient with heparin-induced thrombocytopenia type II during mitral valve replacement using argatroban anticoagulation. J Anesth 2013; 27 (06) 951-955
• 21 Wilde MI, Markham A. Danaparoid. A review of its pharmacology and clinical use in the management of heparin-induced thrombocytopenia. Drugs 1997; 54 (06) 903-924
• 22 Krauel KO, Furll BO, Warkentin TE. et al. Heparin-induced thrombocytopenia – therapeutic concentrations of danaparoid, unlike fondaparinux and direct thrombin inhibitors, inhibit formation of platelet factor 4-heparin complexes. J Thromb Haemost 2008; 6 (12) 2160-2167
• 23 Westphal K, Martens S, Strouhal U. et al. Heparin-induced thrombocytopenia type II: perioperative management using danaparoid in a coronary artery bypass patient with renal failure. Thorac Cardiovasc Surg 1997; 45 (06) 318-320
• 24 Koster A, Meyer O, Fischer T. et al. One-year experience with the platelet glycoprotein IIb/IIIa antagonist tirofiban and heparin during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II. J Thorac Cardiovasc Surg 2001; 122 (06) 1254-1255
• 25 Koster A, Kukucka M, Bach F. et al. Anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II and renal impairment using heparin and the platelet glycoprotein IIb-IIIa antagonist tirofiban. Anesthesiology 2001; 94 (02) 245-251
• 26 Palatianos G, Michalis A, Alivizatos P. et al. 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. Am J Hematol 2015; 90 (07) 608-617
• 27 Palatianos GM, Foroulis CN, Vassili MI. et al. Preoperative detection and management of immune heparin-induced thrombocytopenia in patients undergoing heart surgery with iloprost. J Thorac Cardiovasc Surg 2004; 127 (02) 548-554
• 28 Commin PL, Rozec B, Trossaert M, Le Teurnier Y, Fournet X, Blanloeil Y. Use of heparin and platelet GPIIbIIIa inhibitor tirofiban for cardiac surgery in patients for suspicion of heparin-induced thrombocytopenia. Ann Fr Anesth Reanim 2006; 25 (11-12): 1153-1157
• 29 Chong BH, Burgess J, Ismail F. The clinical usefulness of the platelet aggregation test for the diagnosis of heparin-induced thrombocytopenia. Thromb Haemost 1993; 69 (04) 344-350
• 30 DiSesa VJ, Huval W, Lelcuk S. et al. Disadvantages of prostacyclin infusion during cardiopulmonary bypass: a double-blind study of 50 patients having coronary revascularization. Ann Thorac Surg 1984; 38 (05) 514-519
• 31 Gernhofer YK, Banks DA, Golts E, Pretorius V. Novel use of cangrelor with heparin during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia who require cardiovascular surgery: a case series. Semin Thorac Cardiovasc Surg 2020; 32 (04) 763-769
• 32 Girgis AM, Golts E, Humber D, Banks DA. Successful use of cangrelor and heparin for cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia and end-stage renal disease: a case report. A A Pract 2019; 13 (01) 10-12
• 33 Scala E, Pitta-Gros B, Pantet O. et al. Cardiac surgery successfully managed with cangrelor in a patient with persistent anti-PF4/heparin antibodies 8 years after heparin-induced thrombocytopenia. J Cardiothorac Vasc Anesth 2019; 33 (11) 3073-3077
• 34 Seider S, Ross M, Pretorius V, Maus T. The use of cangrelor and heparin for anticoagulation in a patient requiring pulmonary thromboendarterectomy surgery with suspected heparin-induced thrombocytopenia. J Cardiothorac Vasc Anesth 2019; 33 (04) 1050-1053
• 35 Scala E, Gerschheimer C, Gomez FJ, Alberio L, Marcucci C. Potential and limitations of the new P2Y12 inhibitor, cangrelor, in preventing heparin-induced platelet aggregation during cardiac surgery: an in vitro study. Anesth Analg 2020; 131 (02) 622-630
• 36 Welsby IJ, Um J, Milano CA, Ortel TL, Arepally G. Plasmapheresis and heparin reexposure as a management strategy for cardiac surgical patients with heparin-induced thrombocytopenia. Anesth Analg 2010; 110 (01) 30-35
• 37 Warkentin TE, Sheppard JA, Chu FV, Kapoor A, Crowther MA, Gangji A. Plasma exchange to remove HIT antibodies: dissociation between enzyme-immunoassay and platelet activation test reactivities. Blood 2015; 125 (01) 195-198
• 38 Anderson D, Ali K, Blanchette V. et al. Guidelines on the use of intravenous immune globulin for hematologic conditions. Transfus Med Rev 2007; 21 (02) (Suppl. 01) S9-S56
• 39 Warkentin TE. High-dose intravenous immunoglobulin for the treatment and prevention of heparin-induced thrombocytopenia: a review. Expert Rev Hematol 2019; 12 (08) 685-698
• 40 Koster A, Nazy I, Birschmann IE, Smith JW, Sheppard JI, Warkentin TE. High-dose IVIG plus cangrelor platelet “anesthesia” during urgent heparin-CPB in a patient with recent SRA-negative HIT-thrombosis with persisting platelet-activating antibodies. Res Pract Thromb Haemost 2020; 4 (06) 1060-1064