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J Thorac Cardiovasc Surg 2003;126:2109
© 2003 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor:

Michel Carrier, MDa

a Department of Surgery, Montreal Heart Institute, Research Center, Montreal, Quebec, Canada

I thank Dr Baciewicz for his comments regarding our article and thank you for the opportunity to respond to him. We chose to compare low dose of the anti-Xa inhibitor danaparoid with standard heparin in off-pump coronary artery bypass grafting because of our significant clinical experience with the former drug. Although it is not superior to standard heparin, low-dose danaparoid offers a safe alternative for patients undergoing off-pump coronary artery bypass grafting when heparin is contraindicated.

My group and I have read with interest the reports on bivalirudin, but we remain concerned by the limited clinical data available. In fact, we found only two reports of cardiac surgical patients in the literature, with one of the patients showing a large blood drainage through the chest tubes.1,2

Our current options for patients with heparin-induced thrombocytopenia are to use low-dose danaparoid and off-pump coronary artery bypass grafting or to wait for disappearance of the antiplatelet antibodies and use a standard protocol of heparin.


   References
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 References
 

  1. Vasquez JC, Vichiendilokkul A, Mahmood S, Baciewicz FA. Anticoagulation with bivalirudin during cardiopulmonary bypass in cardiac surgery. Ann Thorac Surg. 2002;74:2177–2179
  2. Davis Z, Anderson R, Short D, Garber D, Valgiusti A. Favorable outcome with bivalirudin anticoagulation during cardiopulmonary bypass. Ann Thorac Surg. 2003;75:264–265

Related Article

Reply to the Editor
Martin McKneally
J. Thorac. Cardiovasc. Surg. 2003 126: 2108. [Extract] [Full Text] [PDF]




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