Update on heparin-induced thrombocytopenia and cardiovascular interventions.
Although heparin/protamine has been the standard anticoagulation regimen in cardiac surgery for decades, it induces negative reactions within the vasculature. Heparin-induced thrombocytopenia (HIT) is a highly prothrombotic immune reaction to heparin that may result in death, limb ischemia leading to amputation, graft occlusion, and other severe thrombotic events. Patients undergoing cardiac surgery are at high risk for HIT antibody seroconversion and at risk for clinical HIT. For patients with acute or subacute HIT and needing urgent cardiac surgery, accepted protocols for alternative, non-heparin anticoagulation are needed. The direct thrombin inhibitor bivalirudin offers promise in this area and is currently being evaluated in multicenter trials as an alternative for heparin/protamine in patients with HIT undergoing cardiac surgery.
Spiess
Bruce D
BD
Department of Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0695, USA. bdspiess@hsc.vcu.edu
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001323:Autoantibodies / Q000276:immunology; D001327:Autoimmune Diseases / Q000139:chemically induced / Q000150:complications / Q000276:immunology; D006348:Cardiac Surgical Procedures / Q000379:methods; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D015337:Multicenter Studies as Topic; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013903:Thoracic Surgery; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications / Q000276:immunology
D000925:Anticoagulants; D001323:Autoantibodies; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin