This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Nuttall, G. A. Articles by Zehr, K. J. Search for Related Content PubMed PubMed Citation Articles by Nuttall, G. A. Articles by Zehr, K. J. Related Collections Blood Surgery Heart

---

CARDIOVASCULAR ANESTHESIA

Patients with a History of Type II Heparin-Induced Thrombocytopenia with Thrombosis Requiring Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Observational Case Series

Gregory A. Nuttall, MD^*, William C. Oliver, Jr, MD^*, Paula J. Santrach, MD, Robert D. McBane, MD, Daniel B. Erpelding, CCP^||, Christina L. Marver, MT (ASAP)^||, and Kenton J. Zehr, MD

Department of *Anesthesiology and Laboratory Medicine, Division of Hematology, and Division of Cardiovascular Surgery, ||Mayo Clinic, Rochester, Minnesota

Address correspondence and reprint requests to Gregory A. Nuttall, MD, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905. Address e-mail to nuttall.gregory{at}mayo.edu

Heparin-induced thrombocytopenia with thrombosis (HITT) type II is a life-threatening complication of heparin therapy that most often occurs after 5–10 days of exposure to heparin. Anticoagulation is a significant concern for patients with HITT type II being prepared for cardiac surgery requiring cardiopulmonary bypass (CPB). We report a case series of 12 patients with a history HITT type II who underwent CPB and cardiac surgery. Six patients did not express the antibody that mediates HITT type II immediately before surgery. Heparin was used as the anticoagulant for the duration of CPB only, and all these patients did well without thrombotic complications. Six patients expressed the antibody that mediates HITT type II immediately before surgery. Hirudin was used as the anticoagulant for CPB in these patients. The ecarin clotting time was used to guide hirudin therapy during CPB. The patients receiving hirudin did well, but they had a large amount of bleeding, required transfusions of multiple allogeneic blood products, and had a frequent rate of reexploration of the mediastinum after CPB.

IMPLICATIONS: We report a case series of 12 patients with a clinical history of type II heparin-induced thrombocytopenia and describe their hematologic management during cardiac surgery with cardiopulmonary bypass.

This article has been cited by other articles:

				S. Selleng, A. Haneya, S. Hirt, K. Selleng, C. Schmid, and A. Greinacher Management of anticoagulation in patients with subacute heparin-induced thrombocytopenia scheduled for heart transplantation Blood, November 15, 2008; 112(10): 4024 - 4027. [Abstract] [Full Text] [PDF]

				S. M. Dellaria, P. E. Greilich, and R. Sarode Urgent Cardiac Surgery in a Patient with a Remote History of Heparin-Induced Thrombocytopenia: Use of the Anti-PF4/Heparin ELISA Confirmatory Test Anesth. Analg., August 1, 2008; 107(2): 379 - 381. [Abstract] [Full Text] [PDF]

				T. E. Warkentin, A. Greinacher, A. Koster, and A. M. Lincoff Treatment and Prevention of Heparin-Induced Thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 340S - 380S. [Abstract] [Full Text] [PDF]

				J. H. Levy, K. A. Tanaka, and M. J. Hursting Reducing Thrombotic Complications in the Perioperative Setting: An Update on Heparin-Induced Thrombocytopenia Anesth. Analg., September 1, 2007; 105(3): 570 - 582. [Abstract] [Full Text] [PDF]

				P. Kopterides What Is the Appropriate Anticoagulation Therapy in Patients with a History of Heparin-Induced Thrombocytopenia? Anesth. Analg., December 1, 2005; 101(6): 1885 - 1885. [Full Text] [PDF]

				E. D. Iannoli, M. P. Eaton, and J. R. Shapiro Bidirectional Glenn Shunt Surgery Using Lepirudin Anticoagulation in an Infant with Heparin-Induced Thrombocytopenia with Thrombosis Anesth. Analg., July 1, 2005; 101(1): 74 - 76. [Abstract] [Full Text] [PDF]

				C. S. Carr, A. Rayner, J. Ponte, and J. B. Desai Off-Pump Coronary Artery Bypass Grafting in a Heparin-Induced Thrombocytopenia Type II Patient Using Hirudin Ann. Thorac. Surg., February 1, 2005; 79(2): 696 - 698. [Abstract] [Full Text] [PDF]

				K. Hassell The Management of Patients With Heparin-Induced Thrombocytopenia Who Require Anticoagulant Therapy Chest, February 1, 2005; 127(2_suppl): 1S - 8S. [Abstract] [Full Text] [PDF]

				T. E. Warkentin and A. Greinacher Heparin-Induced Thrombocytopenia: Recognition, Treatment, and Prevention: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 311S - 337S. [Abstract] [Full Text] [PDF]

				G. Stratmann, A. M. deSilva, E. E. Tseng, J. Hambleton, M. Balea, A. J. Romo, M. J. Mann, N. L. Achorn, W. F. Moskalik, and C. W. Hoopes Reversal of Direct Thrombin Inhibition After Cardiopulmonary Bypass in a Patient with Heparin-Induced Thrombocytopenia Anesth. Analg., June 1, 2004; 98(6): 1635 - 1639. [Abstract] [Full Text] [PDF]

				P. J. Santrach Devices for Monitoring Heparin and Protamine in the Operating Room Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 379 - 385. [Abstract] [PDF]

				W. C. Oliver Jr Overview of Heparin and Protamine Management and Dosing Regimens in Pediatric Cardiac Surgical Patients Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 387 - 410. [Abstract] [PDF]