Semin Thromb Hemost 2004; 30(3): 315-327
DOI: 10.1055/s-2004-831044
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

The Use of Direct Thrombin Inhibitors in Cardiovascular Surgery in Patients with Heparin-Induced Thrombocytopenia

Andreas Greinacher1
  • 1Professor, Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Diagnostikzentrum, Greifswald, Germany.
Further Information

Publication History

Publication Date:
29 July 2004 (online)

One of the most important adverse drug reactions that physicians encounter is the life- and limb-threatening prothrombotic syndrome known as heparin-induced thrombocytopenia (HIT). Unfractionated heparin (UFH), administered during cardiopulmonary bypass (CPB), is highly immunogenic. Heparin-dependent antibodies can develop in 25 to 50% of UFH-treated cardiac surgery patients within 5 to 10 days. These antibodies can activate platelets and are considered the causative agents of HIT. HIT is a relatively common complication, occurring in 1 to 3% of cardiovascular surgery patients when UFH administration is continued postoperatively. It is strongly associated with new thromboembolic events leading to limb amputation and death. In acute or recent (< 100 days) HIT, alternative anticoagulatory regimens are needed during CPB surgery for prevention of HIT-related thrombosis. Treatment options for such patients now generally include the use of alternative anticoagulants such as lepirudin, bivalirudin, or danaparoid, as well as a combined treatment with platelet-function inhibitors and heparin. In patients with a history of HIT and no detectable antibodies, heparin is currently the safest approach for high-dose anticoagulation during CPB. Before and after surgery, however, alternative anticoagulants should be used. The risk of clinical HIT after heart surgery could potentially be reduced by using low-molecular-weight heparins for postsurgery anticoagulation.

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 Prof. Dr. med.
Andreas Greinacher

Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Diagnostikzentrum, Sauerbruchstraße

17487 Greifswald, Germany

Email: greinach@uni-greifswald.de