Cardiac surgery with cardiopulmonary bypass in patients with type II heparin-induced thrombocytopenia.
BACKGROUND
The use of cardiopulmonary bypass (CPB) in patients with a history of type II heparin-induced thrombocytopenia (HIT) may be associated with complications related to their anticoagulation management.


METHODS
Between January 1997 and December 1999, among 4,850 adults patients who underwent cardiac surgery in our institution, 10 patients presented with preoperative type II HIT. In 4 patients, anticoagulation during CPB was achieved with danaparoid sodium. In 6 other patients, heparin sodium was used after pretreatment with epoprostenol sodium.


RESULTS
No significant change in platelet count occurred in any patient. No intraoperative thrombotic complication was encountered. Total postoperative chest drainage ranged from 250 to 1,100 ml in patients pretreated with epoprostenol and 1,700 to 2,470 ml in patients who received danaparoid sodium during CPB (p < 0.05, Mann-Whitney U test).


CONCLUSIONS
During CPB, inhibition of platelet aggregation by prostacyclin may be a safe anticoagulation approach in patients with type II HIT.
Service d'Anesthésie--Réanimation and EA 1896, Université Claude Bernard Lyon I, France. a.aouifi@free.fr
A
A
Aouifi
P
P
Blanc
V
V
Piriou
O H
OH
Bastien
P
P
Ffrench
M
M
Hanss
J J
JJ
Lehot
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass; D002809:Chondroitin Sulfates / Q000008:administration & dosage; D001026:Coronary Artery Bypass; D003871:Dermatan Sulfate / Q000008:administration & dosage; D004338:Drug Combinations; D011464:Epoprostenol / Q000008:administration & dosage; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006497:Heparan Sulfate / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000145:classification
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D011464:Epoprostenol; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid