Heparin-induced thrombocytopenia and cardiac surgery
- PMID: 12902132
- DOI: 10.1016/s0003-4975(03)00756-2
Heparin-induced thrombocytopenia and cardiac surgery
Corrected and republished in
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Heparin-induced thrombocytopenia and cardiac surgery.Ann Thorac Surg. 2003 Dec;76(6):2121-31. doi: 10.1016/j.athoracsur.2003.09.034. Ann Thorac Surg. 2003. PMID: 14667668 Review.
Abstract
Unfractionated heparin given during cardiopulmonary bypass is remarkably immunogenic, as 25% to 50% of postcardiac surgery patients develop heparin-dependent antibodies during the next 5 to 10 days. Sometimes, these antibodies strongly activate platelets and coagulation, thereby causing the prothrombotic disorder, heparin-induced thrombocytopenia. The risk of heparin-induced thrombocytopenia is 1% to 3% if unfractionated heparin is continued throughout the postoperative period. When cardiac surgery is urgently needed for a patient with acute or subacute heparin-induced thrombocytopenia, options include an alternative anticoagulant (bivalirudin, lepirudin, or danaparoid) or combining unfractionated heparin with a platelet antagonist (epoprostenol or tirofiban). As heparin-induced thrombocytopenia antibodies are transient, unfractionated heparin alone is appropriate in a patient with previous heparin-induced thrombocytopenia whose antibodies have disappeared.
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