Cardiac surgery in patients with heparin induced thombocytopenia (HIT II)

Heparin-induced thrombocytopenia (HIT) might be lifethreatening in patients undergoing open heart surgery, due to thromboembolic events, thrombocytopenia and bleeding. If cardiac surgery with cardiopulmonary bypass (CPB) is necessary, anticoagulation therapy will be based on usage of danaparoid or d...

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Bibliographic Details
Published in:	Acta chirurgica Iugoslavica Vol. 56; no. 1; pp. 47 - 52
Main Authors:	Jovic, M.D., Nezic, D.G., Calija, B.M., Nenadic, D.S., Knezevic, A.M., Borzanovic, M.D., Krivokapic, B.M., Petrovic, I.M., Djukanovic, B.P.
Format:	Journal Article
Language:	English
Published:	2009
Online Access:	Get full text
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Summary:	Heparin-induced thrombocytopenia (HIT) might be lifethreatening in patients undergoing open heart surgery, due to thromboembolic events, thrombocytopenia and bleeding. If cardiac surgery with cardiopulmonary bypass (CPB) is necessary, anticoagulation therapy will be based on usage of danaparoid or direct thrombin inhibitors. Female patient was switched from per oral anticoagulant therapy to low molecular heparin therapy preparing for reredo mitral valve replacement due to endocarditis and artificial valve thrombosis. In next 10 days, thrombocytopenia was obvious (Tr 302 000 mm3 to 11 000 mm3) , and diagnoses of HIT were done. Anticoagulant therapy was continued with danaparoid, 750 IU/12 h sc. During the surgery, reredo mitral valve replacement and aortocoronary bypass on anterior descending coronary artery, blood salvage technique with rhirudin( intravenous bolus 0,4 mg/kg, in CPB prajming solution 0,4mg/kg and continuous infusion during CPB 0,15 mg/kg/h ) during cardiopulmonary bypass was used. Active coagulation time and +++ were monitored, without any sign of micro thrombosis in circuit. Postoperatively, per oral anticoagulation therapy was initiated with prolonged postoperative treatment due to basic disease, endocarditis. Patient was discharged from hospital on 21-st postoperative day without any complication. Heparinom indukovana trombocitopenija (HIT), kod bolesnika koji se podvrgavaju kardiohirurskim operacijama zahteva alternativnu antikoagulacionu terapiju upotrebom heparinoida ili lekova sa direktnim antitrombinskim delovanjem. Bolesnica je primljena radi rereoperacije na mehanickoj mitralnoj valvuli (Reredo MVR) zbog endokarditisa i tromba na vestackoj valvuli koja je zamenjena pre 11 godina. U preoperativnoj pripremi, peroralna antikoagulantna terapija se zamenjuje niskomolekularnim heparinom. U narednih deset dana ocigledna je progresivna trombocitopenija (broj Tr sa 302 000 mm3 na 11 000 mm3) kada se posumnjalo na HIT II. U preoperativnoj pripremi koriscen je danaparoid 750 IJ/12 h sc. Uradjena je rereoperacija MVR i revaskularizacija RIA. Tokom VTK-a koriscen je rhirudin (intravenski bolus 0,4 mg/kg, VTK prajming 0,4 mg/kg uz kontinuiranu infuziju 0,15 mg/kg/h do kraja VTK-a) uz intraoperativno spasavanje krvi. U postoperativnom toku uvodi se peroralna antikoagulantnu terapija. Posle produzenog postoperativnog lecenja (21-og postoperativnog dana) otpusta se bez komplikacija vezanih za HIT ili endokarditis.
ISSN:	0354-950X 2406-0887
DOI:	10.2298/ACI0901047J