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Meshulami N, Murthy R, Meyer M, Meyer AD, Kaushik S. Bivalirudin anticoagulation for cardiopulmonary bypass during cardiac surgery. Perfusion 2023:2676591231221708. [PMID: 38084653 DOI: 10.1177/02676591231221708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Heparin is the primary anticoagulant for cardiopulmonary bypass (CPB) support during cardiac surgery. While widely used, ∼2% of cardiac surgery patients develop heparin-induced thrombocytopenia (HIT) and 4-26% develop heparin resistance. Bivalirudin is an alternative anticoagulant mainly used for percutaneous coronary interventions. Given the challenges associated with heparin anticoagulation, we conducted a review to explore the use of bivalirudin for CPB surgery. METHODS PubMed and Embase scoping review included 2 randomized controlled trials, a retrospective comparison study, 3 pilot studies, and 30 case reports. To provide a contemporary series, we searched for articles published from 2010 to 2023. Our review included studies from both adult and pediatric populations. RESULTS While data is limited, bivalirudin seems to supply similar effectiveness and safety as heparin for CPB anticoagulation. Across the three comparative studies, the heparin cohorts had a 0-9% mortality rate and 0-27% rate of major bleeding/reoperation compared to a 0-3% mortality and 0-6% major bleeding/reoperation rate for the bivalirudin cohorts. Bivalirudin was successfully used as an anticoagulant in a wide range of CPB surgeries (e.g., heart transplants, ventricular assisted device placements, and valve repairs). Successful patient outcomes were reported with bivalirudin infusion of ∼2 mg/kg/hour, activated clotting time monitoring (target >400 s or 2.5× baseline), use of cardiotomy suctions, minimization of stagnant blood, and post-bypass modified ultrafiltration. CONCLUSION Bivalirudin is a safe and effective anticoagulant for CPB, especially for patients with HIT or heparin resistance. Further comparative research is called for to optimize bivalirudin utilization for CPB during cardiac surgery.
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Affiliation(s)
- Noy Meshulami
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raghav Murthy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pediatric Cardiac Surgery, Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maisy Meyer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew D Meyer
- Division of Critical Care, Department of Pediatrics, Long School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Shubhi Kaushik
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Pediatric Critical Care, Department of Pediatrics, Kravis Children's Hospital at Mount Sinai, Icahn School of Medicine, New York, NY, USA
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GTH 2021 State of the Art-Cardiac Surgery: The Perioperative Management of Heparin-Induced Thrombocytopenia in Cardiac Surgery. Hamostaseologie 2021; 41:59-62. [PMID: 33588456 DOI: 10.1055/a-1336-6116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is a severe, immune-mediated, adverse drug reaction that paradoxically induces a prothrombotic state. Particularly in the setting of cardiac surgery, where full anticoagulation is required during cardiopulmonary bypass, the management of HIT can be highly challenging, and requires a multidisciplinary approach. In this short review, the different perioperative strategies to run cardiopulmonary bypass will be summarized.
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Koster A, Erdoes G, Nagler M, Birschmann I, Alberio L. How would we treat our own heparin-induced thrombocytopenia during cardiac surgery? J Cardiothorac Vasc Anesth 2020; 35:1585-1593. [PMID: 33342734 DOI: 10.1053/j.jvca.2020.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 12/29/2022]
Abstract
The aim of this article is to provide a comprehensive review of the current state of knowledge on heparin-induced thrombocytopenia (HIT) in cardiac surgery. The management of HIT patients undergoing cardiac surgery with cardiopulmonary bypass is complex and requires an interdisciplinary and patient-tailored approach because available evidence is limited and current anticoagulation strategies have potential risks. An index case is used to discuss both the established and new perioperative therapeutic options in HIT patients undergoing urgent cardiac surgery with cardiopulmonary bypass.
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Affiliation(s)
- Andreas Koster
- Institute of Anesthesiology and Pain Therapy, Heart, and Diabetes Center NRW, Bad Oeynhausen, Ruhr-University Bochum, Bochum, Germany
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Michael Nagler
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ingvild Birschmann
- Institute of Laboratory and Transfusion Medicine, Heart, and Diabetes Center NRW, Bad Oeynhausen, Ruhr-University Bochum, Bochum, Germany
| | - Lorenzo Alberio
- Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
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Erdoes G, Ortmann E, Martinez Lopez De Arroyabe B, Reid C, Koster A. Role of Bivalirudin for Anticoagulation in Adult Perioperative Cardiothoracic Practice. J Cardiothorac Vasc Anesth 2020; 34:2207-2214. [DOI: 10.1053/j.jvca.2019.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/25/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022]
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Neethling E, Moreno Garijo J, Mangalam TK, Badiwala MV, Billia P, Wasowicz M, Van Rensburg A, Slinger P. Intraoperative and Early Postoperative Management of Heart Transplantation: Anesthetic Implications. J Cardiothorac Vasc Anesth 2020; 34:2189-2206. [DOI: 10.1053/j.jvca.2019.09.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/07/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022]
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Nishida H, Fukuhara H, Yamagishi A, Hosoya N, Ichiyanagi O, Sakurai T, Naito S, Yamanobe T, Kato T, Tsuchiya N. Living kidney transplantation without perioperative anticoagulation therapy for a patient with heparin-induced thrombocytopenia. IJU Case Rep 2020; 3:86-89. [PMID: 32743478 PMCID: PMC7292195 DOI: 10.1002/iju5.12148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/28/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Heparin-induced thrombocytopenia is an antibody-mediated acquired prothrombotic state induced by heparin exposure. The risk of thromboembolic diseases in kidney transplantation with heparin-induced thrombocytopenia without perioperative anticoagulation has not been determined. CASE PRESENTATION A 64-year-old male hemodialysis patient with heparin-induced thrombocytopenia was referred to our hospital for living kidney transplantation. Anti-heparin-induced thrombocytopenia antibody was positive at the time of referral; however, it turned negative 4 months after heparin cessation during hemodialysis sessions. Living kidney transplantation by donation from his wife was performed using the standard technical procedure. Both heparinization and application of medical equipment containing heparin were avoided; however, no anticoagulant was administered intra- and postoperatively. The graft kidney functioned immediately, and no thromboembolic event related to heparin-induced thrombocytopenia occurred. CONCLUSION Kidney transplantation without perioperative anticoagulation therapy after disappearance of anti-heparin-induced thrombocytopenia antibody is a well-tolerated treatment option for patients with end-stage kidney disease.
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Affiliation(s)
- Hayato Nishida
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
| | - Hiroki Fukuhara
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
| | - Atsushi Yamagishi
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
| | - Noriyuki Hosoya
- Department of UrologyTsuruoka Municipal Shonai HospitalYamagataJapan
| | - Osamu Ichiyanagi
- Department of UrologyYamagata Prefectural Kahoku HospitalYamagataJapan
| | - Toshihiko Sakurai
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
| | - Sei Naito
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
| | - Takuya Yamanobe
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
| | - Tomoyuki Kato
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
| | - Norihiko Tsuchiya
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
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Taguchi K, Ishiyama K, Ide K, Ohira M, Tahara H, Ohdan H. Simultaneous Liver-Kidney Transplantation in Patient with a History of Heparin-Induced Thrombocytopenia: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:980-987. [PMID: 31285416 PMCID: PMC6640169 DOI: 10.12659/ajcr.916717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patient: Male, 58 Final Diagnosis: Heparin-induced thrombocytopenia Symptoms: Liver and kidney failure Medication: — Clinical Procedure: Simultaneous liver-kidney transplantation Specialty: Transplantology
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Affiliation(s)
- Kazuhiro Taguchi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.,Institute for Clinical Research, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.,Department of Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
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Ivascu NS, Fitzgerald M, Ghadimi K, Patel P, Evans AS, Goeddel LA, Shaefi S, Klick J, Johnson A, Raiten J, Horak J, Gutsche J. Heparin-Induced Thrombocytopenia: A Review for Cardiac Anesthesiologists and Intensivists. J Cardiothorac Vasc Anesth 2019; 33:511-520. [DOI: 10.1053/j.jvca.2018.10.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 01/02/2023]
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Hirasaki Y, Yamamoto Y, Nakamura T, Higa Y, Honda M, Yoshida S. Rotational Thromboelastometry for Coagulation Management During Cardiopulmonary Bypass Using Argatroban. J Cardiothorac Vasc Anesth 2018; 33:1977-1982. [PMID: 30529181 DOI: 10.1053/j.jvca.2018.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Yuji Hirasaki
- Department of Anesthesia, IMS Tokyo Katsushika General Hospital, Tokyo, Japan.
| | - Yosuke Yamamoto
- Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
| | - Tomokazu Nakamura
- Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
| | - Yuki Higa
- Department of Anesthesia, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
| | - Masahiro Honda
- Department of Anesthesia, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
| | - Shigehiko Yoshida
- Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
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Lee CL, Colombo PC, Eisenberger A, Diuguid D, Jennings DL, Han J, Salna MP, Takeda K, Kurlansky PA, Yuzefpolskaya M, Garan AR, Naka Y, Takayama H. Abciximab/Heparin Therapy for Left Ventricular Assist Device Implantation in Patients With Heparin-Induced Thrombocytopenia. Ann Thorac Surg 2018; 105:122-128. [DOI: 10.1016/j.athoracsur.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/21/2017] [Accepted: 06/07/2017] [Indexed: 12/13/2022]
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