HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kappa, J. R. Articles by Addonizio, V. P. Search for Related Content PubMed PubMed Citation Articles by Kappa, J. R. Articles by Addonizio, V. P.

The Annals of Thoracic Surgery, Vol 49, 714-722, Copyright © 1990 by The Society of Thoracic Surgeons

ARTICLES

Intraoperative management of patients with heparin-induced thrombocytopenia

JR Kappa, CA Fisher, B Todd, N Stenach, P Bell, F Campbell, N Ellison and VP Addonizio
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia.

For 11 patients with confirmed heparin-induced thrombocytopenia, we used reversible platelet inhibition with iloprost, a stable prostacyclin analogue, to permit safe heparin administration for cardiac (n = 9) or vascular (n = 2) operations. In vitro, iloprost (0.01 mumol/L) prevented both heparin-induced platelet aggregation and 14C-serotonin release in all patients. Therefore, intraoperatively, a continuous infusion of iloprost was started before administration of heparin and was continued until 15 minutes after administration of protamine. For cardiac patients, after heparin administration, the whole blood platelet count did not change (171,000 +/- 29,000/microL versus 174,000 +/- 29,000/microL, mean +/- standard error of the mean); no spontaneous platelet aggregation was observed, and plasma levels of the alpha-granule constituents platelet factor 4 and beta- thromboglobulin increased from 38 +/- 14 and 140 +/- 18 ng/mL to 591 +/- 135 and 235 +/- 48 ng/mL, respectively. Fibrinopeptide A levels actually decreased from 287 +/- 150 to 27 +/- 6 ng/mL. Furthermore, adenosine diphosphate-induced platelet activation was preserved, postoperative bleeding times were unchanged, and no heparin-related deaths occurred. Similar results were obtained in both vascular patients. We conclude that temporary platelet inhibition with iloprost now permits safe heparin administration in all patients with heparin- induced thrombocytopenia who require a cardiac or vascular operation.

This article has been cited by other articles:

				D Belway, F D Rubens, B Henley, A Babaev, and T Mesana Delayed thrombin generation is not associated with fibrinopeptide formation during prolonged cardiopulmonary bypass with hirudin anticoagulation Perfusion, September 1, 2006; 21(5): 259 - 262. [Abstract] [PDF]

				F. D. Rubens, G. Lavalee, M. A. Ruel, T. Mesana, and M. Bourke Delayed Thrombin Generation With Hirudin Anticoagulation During Prolonged Cardiopulmonary Bypass Ann. Thorac. Surg., January 1, 2005; 79(1): 334 - 336. [Abstract] [Full Text] [PDF]

				S. Tabata, S. Yamaguchi, H. Nagamine, S. Tomita, S. Arai, H. Takemura, and G. Watanabe Efficacy of FK633, an ultra-short acting glycoprotein IIb/IIIa antagonist on platelet preservation during and after cardiopulmonary bypass Eur. J. Cardiothorac. Surg., August 1, 2004; 26(2): 289 - 293. [Abstract] [Full Text] [PDF]

				G. M. Palatianos, C. N. Foroulis, M. I. Vassili, P. Matsouka, G. M. Astras, G. H. Kantidakis, E. Iliopoulou, and E. N. Melissari Preoperative detection and management of immune heparin-induced thrombocytopenia in patients undergoing heart surgery with iloprost J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 548 - 554. [Abstract] [Full Text] [PDF]

				S. Kanemitsu, M. Nishikawa, K. Onoda, T. Shimono, H. Shimpo, A. Yazaki, K. Tanaka, H. Shiku, and I. Yada Pharmacologic platelet anesthesia by glycoprotein IIb/IIIa complex antagonist and argatroban during in vitro extracorporeal circulation J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 428 - 435. [Abstract] [Full Text] [PDF]

				A. Aouifi, P. Blanc, V. Piriou, O. H. Bastien, P. Ffrench, M. Hanss, and J.-J. Lehot Cardiac surgery with cardiopulmonary bypass in patients with type II heparin-induced thrombocytopenia Ann. Thorac. Surg., February 1, 2001; 71(2): 678 - 683. [Abstract] [Full Text] [PDF]

				Y. Sun, P. E. Greilich, S. I. O. Wilson, M. R. Jackson, and C. W. Whitten The Use of Lepirudin for Anticoagulation in Patients with Heparin-Induced Thrombocytopenia During Major Vascular Surgery Anesth. Analg., February 1, 2001; 92(2): 344 - 346. [Abstract] [Full Text] [PDF]

				F. Follis and C. A. Schmidt Cardiopulmonary bypass in patients with heparin-induced thrombocytopenia and thrombosis Ann. Thorac. Surg., December 1, 2000; 70(6): 2173 - 2181. [Abstract] [Full Text] [PDF]

				R. L. Bick and E. P. Frenkel Clinical Aspects of Heparin-Induced Thrombocytopenia and Thrombosis and Other Side Effects of Heparin Therapy Clinical and Applied Thrombosis/Hemostasis, October 1, 1999; 5(1_suppl): S7 - S15. [Abstract] [PDF]

				Y. Suzuki, P. Hillyer, S. Miyamoto, S. Niewiarowski, L. Sun, A. K. Rao, S. Hollenbach, and L. H. Edmunds Jr Integrilin prevents prolonged bleeding times after cardiopulmonary bypass Ann. Thorac. Surg., August 1, 1998; 66(2): 373 - 381. [Abstract] [Full Text] [PDF]

				J. M. Walenga, B. E. Lewis, D. A. Hoppensteadt, J. Fareed, and M. Bakbos Management of Heparin-Induced Thrombocytopenia and Heparin-Induced Thrombocytopenia and Thrombosis Syndrome Clinical and Applied Thrombosis/Hemostasis, October 1, 1997; 3(1_suppl): S53 - S63. [Abstract] [PDF]

				Y. Hiramatsu, N. Gikakis, H. L. Anderson III, J. H. Gorman III, C. Marcinkiewicz, R. J. Gould, S. Niewiarowski, and L. H. Edmunds Jr. TIROFIBAN PROVIDES ""PLATELET ANESTHESIA"" DURING CARDIOPULMONARY BYPASS IN BABOONS J. Thorac. Cardiovasc. Surg., January 1, 1997; 113(1): 182 - 193. [Abstract] [Full Text]

				M. J. Wilhelm, C. Schmid, D. Kececioglu, T. Mollhoff, H. Ostermann, and H. H. Scheld Cardiopulmonary Bypass in Patients With Heparin-Induced Thrombocytopenia Using Org 10172 Ann. Thorac. Surg., March 1, 1996; 61(3): 920 - 924. [Abstract] [Full Text]

				R. Pifarre State-of-the-Art Review: Optimal Anticoagulation in Cardiovascular Surgery Clinical and Applied Thrombosis/Hemostasis, June 1, 1995; 1(3): 173 - 178. [Abstract] [PDF]

				J. M. Walenga, J. Fareed, R. L. Bick, and R. Pifarre New Anticoagulants for the Cardiovascular Patient Clinical and Applied Thrombosis/Hemostasis, January 1, 1995; 1(1): 24 - 30. [Abstract] [PDF]

				A. Bernabei, N. Gikakis, M. A. Kowalska, S. Niewiarowski, and L. H. Edmunds Jr Iloprost and Echistatin Protect Platelets During Simulated Extracorporeal Circulation Ann. Thorac. Surg., January 1, 1995; 59(1): 149 - 153. [Abstract] [Full Text]