Abstract
Heparin-induced thrombocytopenia (HIT) refers to platelet count reduction that occurs when patients receive heparin therapy, and is a common occurrence in perioperative cardiac surgery patients. This chapter discusses the perioperative considerations regarding thrombocytopenia, including assessing likelihood of occurrence, serological testing, and management options for the patient.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):311S–37S.
Warkentin TE. Clinical picture of heparin-induced thrombocytopenia (HIT) and its differentiation from non-HIT thrombocytopenia. Thromb Haemost. 2016;116(5):813–22.
Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006;4(4):759–65.
Shore-Lesserson L, Baker RA, Ferraris VA, et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines—Anticoagulation During Cardiopulmonary Bypass. Anesth Analg. 2018;126(2):413–24.
Sachan D, Gupta N, Chaudhary R. Rapid diagnosis of heparin-induced thrombocytopenia using a particle gel immunoassay in at-risk cardiac surgery patients. Asian J Transfus Sci. 2013;7(1):92–3.
Bennett-Guerrero E, Slaughter TF, White WD, Welsby IJ, Greenberg CS, El-Moalem H, et al. Preoperative anti-PF4/heparin antibody level predicts adverse outcome after cardiac surgery. J Thorac Cardiovasc Surg. 2005;130(6):1567–72.
Kress DC, Aronson S, McDonald ML, Malik MI, Divgi AB, Tector AJ, et al. Positive heparin-platelet factor 4 antibody complex and cardiac surgical outcomes. Ann Thorac Surg. 2007;83(5):1737–43.
Warkentin TE, Arnold DM, Nazi I, Kelton JG. The platelet serotonin-release assay. Am J Hematol. 2015;90(6):564–72.
Warkentin TE, Sheppard JA, Chu FV, Kapoor A, Crowther MA, Gangji A. Plasma exchange to remove HIT antibodies: dissociation between enzyme-immunoassay and platelet activation test reactivities. Blood. 2015;125(1):195–8.
Agarwal S, Ullom B, Al-Baghdadi Y, Okumura M. Challenges encountered with argatroban anticoagulation during cardiopulmonary bypass. J Anaesthesiol Clin Pharmacol. 2012;28(1):106–10.
Anand SX, Viles-Gonzalez JF, Mahboobi SK, Heerdt PM. Bivalirudin utilization in cardiac surgery: shifting anticoagulation from indirect to direct thrombin inhibition. Can J Anaesth. 2011;58(3):296–311.
Welsby IJ, Um J, Milano CA, Ortel TL, Arepally G. Plasmapheresis and heparin reexposure as a management strategy for cardiac surgical patients with heparin-induced thrombocytopenia. Anesth Analg. 2010;110(1):30–5.
Palatianos GM, Foroulis CN, Vassili MI, Matsouka P, Astras GM, Kantidakis GH, et al. Preoperative detection and management of immune heparin-induced thrombocytopenia in patients undergoing heart surgery with iloprost. J Thorac Cardiovasc Surg. 2004;127(2):548–54.
Palatianos G, Michalis A, Alivizatos P, Lacoumenda S, Geroulanos S, Karabinis A, et al. Perioperative use of iloprost in cardiac surgery patients diagnosed with heparin-induced thrombocytopenia-reactive antibodies or with true HIT (HIT-reactive antibodies plus thrombocytopenia): an 11-year experience. Am J Hematol. 2015;90(7):608–17.
Koster A, Kukucka M, Bach F, Meyer O, Fischer T, Mertzlufft F, et al. Anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II and renal impairment using heparin and the platelet glycoprotein IIb-IIIa antagonist tirofiban. Anesthesiology. 2001;94(2):245–51.
Greinacher A. Heparin-induced thrombocytopenia. N Engl J Med. 2015;373(3):252–61.
Cuker A, Gimotty PA, Crowther MA, Warkentin TE. Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis. Blood. 2012;120(20):4160–7.
Warkentin TE, Kelton JG. Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med. 2001;344(17):1286–92.
Dyke CM, Smedira NG, Koster A, Aronson S, McCarthy HL 2nd, Kirshner R, et al. A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: the EVOLUTION-ON study. J Thorac Cardiovasc Surg. 2006;131(3):533–9.
Merry AF. Bivalirudin, blood loss, and graft patency in coronary artery bypass surgery. Semin Thromb Hemost. 2004;30(3):337–46.
Smedira NG, Dyke CM, Koster A, Jurmann M, Bhatia DS, Hu T, et al. Anticoagulation with bivalirudin for off-pump coronary artery bypass grafting: the results of the EVOLUTION-OFF study. J Thorac Cardiovasc Surg. 2006;131(3):686–92.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Shore-Lesserson, L., Finley, A. (2021). Heparin-Induced Thrombocytopenia and Alternatives to Heparin. In: Cheng, D.C., Martin, J., David, T. (eds) Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-47887-2_25
Download citation
DOI: https://doi.org/10.1007/978-3-030-47887-2_25
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-47886-5
Online ISBN: 978-3-030-47887-2
eBook Packages: MedicineMedicine (R0)