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Case Reports
. 2023 Oct 14;7(7):102230.
doi: 10.1016/j.rpth.2023.102230. eCollection 2023 Oct.

Cangrelor for cardiopulmonary bypass in delayed-onset heparin-induced thrombocytopenia: a case report

Maxime B Durost  1 , Raphaël Marlu  2 , Nicolas Piliero  3 , Alexandre Sebestyen  4 , Damien Bedague  1
Affiliations
Case Reports

Cangrelor for cardiopulmonary bypass in delayed-onset heparin-induced thrombocytopenia: a case report

Maxime B Durost et al. Res Pract Thromb Haemost. .

Abstract

Background: Anticoagulation for cardiopulmonary bypass (CPB) in cases of heparin-induced thrombocytopenia (HIT) is challenging as no convenient and proven alternative, such as heparin alone, exists. A "platelet anesthesia" concept using antiplatelet agent cangrelor with heparin has been successfully reported in this setting.

Key clinical question: In cases of acute HIT, is CPB with cangrelor plus heparin effective and safe?.

Clinical approach: We report the case of a patient who developed, 2 weeks after patent foramen ovale (PFO) closure, a delayed-onset HIT complicated with carotid, popliteal, and PFO device thromboses that could not be controlled by argatroban anticoagulation and required urgent cardiac surgery. CPB for PFO occluder removal and popliteal thrombectomy were performed using cangrelor with heparin without complication. Neither a new thromboembolic event nor abnormal bleeding was noticed in the postoperative period.

Conclusion: CPB using cangrelor with heparin seems to be an effective alternative for acute HIT.

Keywords: cangrelor; cardiopulmonary bypass; heparin; thrombocytopenia; thrombosis.

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Figures

Figure
Figure
Cardiopulmonary bypass (CPB) using heparin and cangrelor: timeline with timing of drugs. Red arrows and numbers indicate the time between injections of the different drugs (heparin, cangrelor, and protamine). The level of heparinization during surgery is indicated by the values of the different activated clotting times (ACTs). ’, minutes; G/L, giga per liter; Hb, hemoglobin; s, seconds; UFH, unfractionated heparin.
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