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J Thorac Cardiovasc Surg 2001;122:1254-1255
© 2001 The American Association for Thoracic Surgery

Brief Communications

One-year experience with the platelet glycoprotein IIb/IIIa antagonist tirofiban and heparin during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II

From the Department of Anaesthesiology,^a Deutsches Herzzentrum Berlin; Blood Bank,^b Humboldt University, Charité, Campus Virchow, Berlin; and Department of Cardiothoracic and Vascular Surgery,^c Deutsches Herzzentrum, Berlin, Germany.

Received for publication May 17, 2001. Accepted for publication June 27, 2001. Address for reprints: Andrea Koster, MD, Department of Anesthesiology, Deutsches Herzzentrum Berlin, Augustenburgerplatz 1, 13353 Berlin, Germany (E-mail: koster@dhzb.de).

Heparins are the standard anticoagulants in clinical medicine. However, in 1% to 3% of all patients this medication is complicated by heparin-induced thrombocytopenia type II (HIT II). This immunologic reaction causes platelet activation and is often associated with thromboses or embolism. Patients with HIT II should not be exposed to heparins. This poses a problem, particularly in cardiac surgery involving cardiopulmonary bypass (CPB), because no safe alternatives to heparin are available. The prolonged biologic elimination and unavailability of an antidote for current alternative anticoagulants, such as danaparoid or r-hirudin, may result in a persistent anticoagulant effect and severe hemorrhage.

Poetzsch, Klovekorn, and Madlener ¹ recently proposed that surgery be delayed until the HIT II antibodies become undetectable in laboratory assays and that unfractionated heparins then be used for anticoagulation during CPB. In those patients, after the short period of "contamination" with unfractionated heparins during CPB, HIT II antibodies remained untraceable. However, this study involved only 10 patients and lacks detail with . . . [Full Text of this Article]

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