PMID- 29853315
OWN - NLM
STAT- MEDLINE
DCOM- 20190715
LR  - 20190715
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 33
IP  - 4
DP  - 2019 Apr
TI  - The Use of Cangrelor and Heparin for Anticoagulation in a Patient Requiring 
      Pulmonary Thromboendarterectomy Surgery with Suspected Heparin-Induced 
      Thrombocytopenia.
PG  - 1050-1053
LID - S1053-0770(18)30284-2 [pii]
LID - 10.1053/j.jvca.2018.04.051 [doi]
AB  - The management of heparin-induced thrombocytopenia (HIT) in the perioperative 
      period for patients undergoing cardiac surgery requiring cardiopulmonary bypass 
      (CPB) and deep hypothermic circulatory arrest (DHCA) can be a challenging 
      clinical scenario. Once a diagnosis of HIT has been established, heparin products 
      typically are avoided and alternative therapies for anticoagulation are started. 
      Alternative anticoagulation strategies for CPB are limited and often have various 
      pharmacokinetic profiles that may lead to increased perioperative bleeding. 
      Historically the use of a GPIIb/IIIa inhibitor, such as tirofiban, followed by 
      unfractionated heparin (UFH) is the typical alternative for surgeries requiring 
      DHCA in patients with HIT at the authors' institution. This article presents a 
      case in which cangrelor followed by UFH was used in a 20-year-old patient with 
      suspected HIT and chronic thromboembolic pulmonary hypertension undergoing 
      pulmonary thromboendarterectomy surgery requiring CPB and DHCA. Due to the 
      frequency of significant postoperative bleeding encountered when using tirofiban 
      and UFH, it was decided to attempt to block platelet aggregation with 
      significantly shorter-acting cangrelor. The authors hypothesized that cangrelor 
      would reduce the risk of significant bleeding compared with tirofiban because of 
      its favorable pharmacokinetics. Specifically, cangrelor has a short elimination 
      half-life of 3 to 6 minutes, and its elimination is not altered by renal and 
      hepatic impairment. This case report discusses the pathophysiology of HIT, the 
      alternative anticoagulants used for HIT type II in pulmonary 
      thromboendarterectomy, and the potential of cangrelor in conjunction with UFH to 
      be a favorable option for patients in similar clinical scenarios.
CI  - Published by Elsevier Inc.
FAU - Seider, Scott
AU  - Seider S
AD  - Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA. 
      Electronic address: Scott.seider.2@gmail.com.
FAU - Ross, Michael
AU  - Ross M
AD  - Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA.
FAU - Pretorius, Victor
AU  - Pretorius V
AD  - Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA.
FAU - Maus, Timothy
AU  - Maus T
AD  - Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20180430
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 415SHH325A (Adenosine Monophosphate)
RN  - 6AQ1Y404U7 (cangrelor)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adenosine Monophosphate/administration & dosage/adverse effects/*analogs & 
      derivatives
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Blood Coagulation/drug effects/physiology
MH  - Drug Therapy, Combination
MH  - Endarterectomy/adverse effects/*methods
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Platelet Aggregation Inhibitors/administration & dosage
MH  - Thrombocytopenia/*chemically induced/*drug therapy
MH  - Young Adult
OTO - NOTNLM
OT  - cangrelor
OT  - cardiopulmonary bypass
OT  - deep hypothermic circulatory arrest
OT  - heparin-induced thrombocytopenia
EDAT- 2018/06/02 06:00
MHDA- 2019/07/16 06:00
CRDT- 2018/06/02 06:00
PHST- 2018/03/27 00:00 [received]
PHST- 2018/06/02 06:00 [pubmed]
PHST- 2019/07/16 06:00 [medline]
PHST- 2018/06/02 06:00 [entrez]
AID - S1053-0770(18)30284-2 [pii]
AID - 10.1053/j.jvca.2018.04.051 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2019 Apr;33(4):1050-1053. doi: 
      10.1053/j.jvca.2018.04.051. Epub 2018 Apr 30.