Cangrelor for cardiopulmonary bypass in delayed-onset heparin-induced thrombocytopenia: a case report.
cangrelor
cardiopulmonary bypass
heparin
thrombocytopenia
thrombosis
Journal
Research and practice in thrombosis and haemostasis
ISSN: 2475-0379
Titre abrégé: Res Pract Thromb Haemost
Pays: United States
ID NLM: 101703775
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
06
12
2022
revised:
01
09
2023
accepted:
19
09
2023
medline:
11
12
2023
pubmed:
11
12
2023
entrez:
11
12
2023
Statut:
epublish
Résumé
Anticoagulation for cardiopulmonary bypass (CPB) in cases of heparin-induced thrombocytopenia (HIT) is challenging as no convenient and proven alternative, such as heparin alone, exists. A "platelet anesthesia" concept using antiplatelet agent cangrelor with heparin has been successfully reported in this setting. In cases of acute HIT, is CPB with cangrelor plus heparin effective and safe?. We report the case of a patient who developed, 2 weeks after patent foramen ovale (PFO) closure, a delayed-onset HIT complicated with carotid, popliteal, and PFO device thromboses that could not be controlled by argatroban anticoagulation and required urgent cardiac surgery. CPB for PFO occluder removal and popliteal thrombectomy were performed using cangrelor with heparin without complication. Neither a new thromboembolic event nor abnormal bleeding was noticed in the postoperative period. CPB using cangrelor with heparin seems to be an effective alternative for acute HIT.
Sections du résumé
Background
UNASSIGNED
Anticoagulation for cardiopulmonary bypass (CPB) in cases of heparin-induced thrombocytopenia (HIT) is challenging as no convenient and proven alternative, such as heparin alone, exists. A "platelet anesthesia" concept using antiplatelet agent cangrelor with heparin has been successfully reported in this setting.
Key Clinical Question
UNASSIGNED
In cases of acute HIT, is CPB with cangrelor plus heparin effective and safe?.
Clinical Approach
UNASSIGNED
We report the case of a patient who developed, 2 weeks after patent foramen ovale (PFO) closure, a delayed-onset HIT complicated with carotid, popliteal, and PFO device thromboses that could not be controlled by argatroban anticoagulation and required urgent cardiac surgery. CPB for PFO occluder removal and popliteal thrombectomy were performed using cangrelor with heparin without complication. Neither a new thromboembolic event nor abnormal bleeding was noticed in the postoperative period.
Conclusion
UNASSIGNED
CPB using cangrelor with heparin seems to be an effective alternative for acute HIT.
Identifiants
pubmed: 38077819
doi: 10.1016/j.rpth.2023.102230
pii: S2475-0379(23)00490-9
pmc: PMC10704493
doi:
Types de publication
Case Reports
Langues
eng
Pagination
102230Informations de copyright
© 2023 The Authors.
Références
Am J Cardiol. 2017 Jul 15;120(2):300-303
pubmed: 28576265
Semin Thorac Cardiovasc Surg. 2020 Winter;32(4):763-769
pubmed: 31610233
Hematology Am Soc Hematol Educ Program. 2021 Dec 10;2021(1):536-544
pubmed: 34889428
J Cardiothorac Vasc Anesth. 2019 Apr;33(4):1050-1053
pubmed: 29853315
Res Pract Thromb Haemost. 2020 Jul 23;4(6):1060-1064
pubmed: 32864557
Blood Adv. 2018 Nov 27;2(22):3360-3392
pubmed: 30482768
Ann Intern Med. 2002 Feb 5;136(3):210-5
pubmed: 11827497
Cochrane Database Syst Rev. 2017 Apr 21;4:CD007557
pubmed: 28431186
Chest. 2012 Feb;141(2 Suppl):e495S-e530S
pubmed: 22315270
Ann Intern Med. 2001 Oct 2;135(7):502-6
pubmed: 11578153
J Cardiothorac Surg. 2018 Apr 17;13(1):30
pubmed: 29665860
J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1751-1757
pubmed: 28864160
Blood Coagul Fibrinolysis. 2023 Apr 1;34(3):224-227
pubmed: 36719810
N Engl J Med. 1995 May 18;332(20):1330-5
pubmed: 7715641
A A Pract. 2019 Jul 1;13(1):10-12
pubmed: 30688681
Chest. 2007 Jun;131(6):1644-9
pubmed: 17400685
Clin Case Rep. 2022 Jul 19;10(7):e6085
pubmed: 35865782