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Ann Thorac Surg 2000;69:774-777
© 2000 The Society of Thoracic Surgeons

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Original Articles

Anticoagulative management of patients requiring left ventricular assist device implantation and suffering from heparin-induced thrombocytopenia type II

^a Department of Thoracic and Cardiovascular Surgery, Westfälische Wilhelms-Universität Münster, Münster, Germany
^b Department of Anesthesiology and Operative Intensive Care Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
^c Department of Experimental and Clinical Hematology, Westfälische Wilhelms-Universität Münster, Münster, Germany

Address reprint requests to Dr Christiansen, Department of Thoracic and Cardiovascular Surgery, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Str 33, 48149 Münster, Germany

Background. Heparin-induced thrombocytopenia type II (HIT II) is a rare but life-threatening side effect of heparin therapy. We describe the perioperative anticoagulative management of patients tested positive for HIT II and requiring implantation of a left ventricular assist device (LVAD).

Methods. We report on 3 patients with a different perioperative anticoagulative management (preoperative, intraoperative, and postoperative anticoagulation with danaparoid-sodium; preoperative anticoagulation with recombinant hirudin, anticoagulation with danaparoid-sodium intraoperatively and postoperatively; preoperative anticoagulation with recombinant hirudin, intraoperative anticoagulation with heparin, and postoperative anticoagulation with danaparoid-sodium) and discuss the difficulties of the treatment.

Results. Anticoagulation with alternative drugs such as recombinant hirudin and danaparoid-sodium led to serious and life-threatening bleeding complications as well as to thromboembolic events in the first 2 patients. Therefore the third patient underwent LVAD implantation using heparin for intraoperative anticoagulation to avoid administration of high doses of recombinant hirudin or danaparoid-sodium. Despite very low anti-factor Xa activities, when using danaparoid-sodium postoperatively, the patient suffered from a bleeding complication on the 4th day after LVAD implantation requiring reexploration.

Conclusions. In selected cases (negative heparin-induced platelet aggregation (HIPA) test at the time of LVAD implantation and continuation of postoperative anticoagulation with recombinant hirudin or danaparoid-sodium), heparin may be used for LVAD implantation in HIT II patients to reduce bleeding complications.

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