Heparin-induced thrombocytopenia and cardiopulmonary bypass: anticoagulation with unfractionated heparin and the GPIIb/IIIa inhibitor tirofiban and successful use of rFVIIa for post-protamine bleeding due to persistent platelet blockade.
Heparin-induced thrombocytopenia was diagnosed in a 50-year-old man on day 5 after cardiac surgery (aorto-coronary bypass and mitral valve replacement). He required redo (para-prosthesis leak) on day 13. The cardiopulmonary bypass (CPB) was performed with unfractionated heparin (UFH) and the platelet glycoprotein (GP) IIb/IIIa inhibitor tirofiban. Post-protamine bleeding likely due to documented persistent platelet blockade by tirofiban was successfully treated with one dose of recombinant activated factor VII (rFVIIa, 60 microg/kg). No thrombotic complications were detected. The management of CPB with UHF and tirofiban is a convenient option and rFVIIa seems appropriate to handle bleeding issues.
Durand
Marion
M
Inserm, U 734, Vandoeuvre-les-Nancy, France; Nancy-Université Université Henri Poincaré, Nancy, France.
Lecompte
Thomas
T
Hacquard
Marie
M
Carteaux
Jean-Pierre
JP
D000925:Anticoagulants / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000379:methods; D004359:Drug Therapy, Combination; D015942:Factor VIIa / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000188:drug therapy; D012086:Reoperation / Q000379:methods; D013921:Thrombocytopenia / Q000139:chemically induced*; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D006493:Heparin; D015942:Factor VIIa; D000077466:Tirofiban