PMID- 36769435
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230213
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 12
IP  - 3
DP  - 2023 Jan 18
TI  - How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during 
      Cardiopulmonary Bypass.
LID - 10.3390/jcm12030786 [doi]
LID - 786
AB  - Heparin-induced thrombocytopenia (HIT) is a major issue in cardiac surgery 
      requiring cardiopulmonary bypass (CPB). HIT represents a severe adverse drug 
      reaction after heparin administration. It consists of immune-mediated 
      thrombocytopenia paradoxically leading to thrombotic events. Detection of 
      antibodies against platelets factor 4/heparin (anti-PF4/H) and aggregation of 
      platelets in the presence of heparin in functional in vitro tests confirm the 
      diagnosis. Patients suffering from HIT and requiring cardiac surgery are at high 
      risk of lethal complications and present specific challenges. Four distinct 
      phases are described in the usual HIT timeline, and the anticoagulation strategy 
      chosen for CPB depends on the phase in which the patient is categorized. In this 
      sense, we developed an institutional protocol covering each phase. It consisted 
      of the use of a non-heparin anticoagulant such as bivalirudin, or the association 
      of unfractionated heparin (UFH) with a potent antiplatelet drug such as tirofiban 
      or cangrelor. Temporary reduction of anti-PF4 with intravenous immunoglobulins 
      (IvIg) has recently been described as a complementary strategy. In this article, 
      we briefly described the pathophysiology of HIT and focused on the various 
      strategies that can be applied to safely manage CPB in these patients.
FAU - Revelly, Etienne
AU  - Revelly E
AUID- ORCID: 0000-0001-8071-676X
AD  - Department of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, 
      Switzerland.
FAU - Scala, Emmanuelle
AU  - Scala E
AUID- ORCID: 0000-0003-0399-3223
AD  - Department of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, 
      Switzerland.
AD  - Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 
      1011 Lausanne, Switzerland.
FAU - Rosner, Lorenzo
AU  - Rosner L
AUID- ORCID: 0000-0002-7301-568X
AD  - Department of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, 
      Switzerland.
FAU - Rancati, Valentina
AU  - Rancati V
AUID- ORCID: 0000-0002-6313-1185
AD  - Department of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, 
      Switzerland.
FAU - Gunga, Ziyad
AU  - Gunga Z
AD  - Department of Cardiac Surgery, Lausanne University Hospital (CHUV), 1011 
      Lausanne, Switzerland.
FAU - Kirsch, Matthias
AU  - Kirsch M
AD  - Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 
      1011 Lausanne, Switzerland.
AD  - Department of Cardiac Surgery, Lausanne University Hospital (CHUV), 1011 
      Lausanne, Switzerland.
FAU - Ltaief, Zied
AU  - Ltaief Z
AUID- ORCID: 0000-0001-9199-4415
AD  - Department of Intensive Care Medicine, Lausanne University Hospital (CHUV), 1011 
      Lausanne, Switzerland.
FAU - Rusca, Marco
AU  - Rusca M
AD  - Department of Intensive Care Medicine, Lausanne University Hospital (CHUV), 1011 
      Lausanne, Switzerland.
FAU - Bechtold, Xavier
AU  - Bechtold X
AD  - Department of Cardiac Surgery, Lausanne University Hospital (CHUV), 1011 
      Lausanne, Switzerland.
FAU - Alberio, Lorenzo
AU  - Alberio L
AUID- ORCID: 0000-0001-9686-9920
AD  - Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 
      1011 Lausanne, Switzerland.
AD  - Division of Hematology and Central Hematology Laboratory, Lausanne University 
      Hospital (CHUV), 1011 Lausanne, Switzerland.
FAU - Marcucci, Carlo
AU  - Marcucci C
AUID- ORCID: 0000-0002-0954-0295
AD  - Department of Anesthesiology, Lausanne University Hospital (CHUV), 1011 Lausanne, 
      Switzerland.
AD  - Faculty of Biology and Medicine, University of Lausanne (UNIL), Rue du Bugnon 21, 
      1011 Lausanne, Switzerland.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20230118
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC9918281
OTO - NOTNLM
OT  - antiplatelet therapy
OT  - cardiac surgery
OT  - cardiopulmonary bypass
OT  - direct thrombin inhibitor
OT  - heparin-induced thrombocytopenia syndrome
OT  - intraoperative management
COIS- The authors declare no conflict of interest.
EDAT- 2023/02/12 06:00
MHDA- 2023/02/12 06:01
PMCR- 2023/01/18
CRDT- 2023/02/11 01:26
PHST- 2022/12/23 00:00 [received]
PHST- 2023/01/13 00:00 [revised]
PHST- 2023/01/16 00:00 [accepted]
PHST- 2023/02/11 01:26 [entrez]
PHST- 2023/02/12 06:00 [pubmed]
PHST- 2023/02/12 06:01 [medline]
PHST- 2023/01/18 00:00 [pmc-release]
AID - jcm12030786 [pii]
AID - jcm-12-00786 [pii]
AID - 10.3390/jcm12030786 [doi]
PST - epublish
SO  - J Clin Med. 2023 Jan 18;12(3):786. doi: 10.3390/jcm12030786.