Heparin-induced thrombocytopenia and cardiopulmonary bypass: anticoagulation with unfractionated heparin and the GPIIb/IIIa inhibitor tirofiban and successful use of rFVIIa for post-protamine bleeding due to persistent platelet blockade

• Published in: European journal of cardio-thoracic surgery Vol. 34; no. 3; pp. 687 - 689
• Main Authors: Durand, Marion, Lecompte, Thomas, Hacquard, Marie, Carteaux, Jean-Pierre
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.09.2008; Elsevier Science
• Subjects: Anticoagulants - adverse effects; Biological and medical sciences; Cardiology. Vascular system; Cardiopulmonary bypass; Cardiopulmonary Bypass - methods; Drug Therapy, Combination; Factor VIIa - therapeutic use; Hematologic and hematopoietic diseases; Heparin - adverse effects; Heparin-induced thrombocytopenia; Humans; Male; Medical sciences; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Platelet diseases and coagulopathies; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Pneumology; Postoperative Complications; Postoperative Hemorrhage - drug therapy; Reoperation - methods; rFVIIa; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thrombocytopenia - chemically induced; Tirofiban; Tyrosine - analogs & derivatives; Tyrosine - therapeutic use; Unfractionated heparin; Cardiopulmonary bypass; Unfractionated heparin; Tirofiban; rFVIIa; Heparin-induced thrombocytopenia; Thrombocytopenia; Glycoprotein IIbIIIa; Use; Hemopathy; Anticoagulant; Hemorrhage; Antiplatelet agent; Platelet; Protamine; Antithrombotic agent; Glycosaminoglycan; Circulatory system; Heparin; Cardiology; Platelet glycoprotein IIb/IIIa receptor antagonist; Biological receptor; Pneumology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2008.05.029

Heparin-induced thrombocytopenia was diagnosed in a 50-year-old man on day 5 after cardiac surgery (aorto-coronary bypass and mitral valve replacement). He required redo (para-prosthesis leak) on day 13. The cardiopulmonary bypass (CPB) was performed with unfractionated heparin (UFH) and the platelet glycoprotein (GP) IIb/IIIa inhibitor tirofiban. Post-protamine bleeding likely due to documented persistent platelet blockade by tirofiban was successfully treated with one dose of recombinant activated factor VII (rFVIIa, 60 μg/kg). No thrombotic complications were detected. The management of CPB with UHF and tirofiban is a convenient option and rFVIIa seems appropriate to handle bleeding issues.