Survey of Practice Pattern in Patients With Heparin-Induced Thrombocytopenia Requiring Cardiopulmonary Bypass

被引:11
作者
Wanat-Hawthorne, Alycia [1 ]
Tanaka, Kenichi [2 ]
Angona, Ronald [3 ]
Feng, Changyong [4 ]
Eaton, Michael [5 ]
机构
[1] Univ Texas Southwestern Med Ctr Dallas, Dept Anesthesiol & Pain Med, 5323 Harry Hines Blvd, Dallas, TX 75093 USA
[2] Univ Maryland, Sch Med, Dept Anesthesiol, Baltimore, MD 21201 USA
[3] Univ Rochester, Med Ctr, Dept Cardiovasc Perfus, Rochester, NY 14642 USA
[4] Univ Rochester, Sch Med & Dent, Dept Biostat & Computat Biol, Rochester, NY USA
[5] Univ Rochester, Sch Med & Dent, Dept Anesthesiol & Perioperat Med, Rochester, NY USA
关键词
CARDIAC-SURGERY; ANTICOAGULATION; BIVALIRUDIN; ANTIBODIES;
D O I
10.1213/ANE.0000000000005721
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction to heparin. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are routinely anticoagulated with heparin before the initiation of bypass. Heparin is contraindicated, however, in patients with acute HIT, and alternatives to routine practice are often used. While guidelines have recently been published addressing this topic 10, there remains variance between institutions in how these cases are treated. Our goal was to better delineate practice trends in the diagnosis and management of HIT patients requiring CPB. METHODS: We surveyed members of the Society of Cardiovascular Anesthesiologists (SCA) and the American Society for Extracorporeal Technology (AmSECT) using an online survey tool. RESULTS: We received 304 completed surveys (5.8% response rate), 75% completed by an anesthesiologist, and 24% by a perfusionist. The majority of respondents used clinical history and/or antibody testing (71% and 63%, respectively) to diagnose HIT. Seventy-five percent of respondents reported using an institutional protocol for HIT-CPB cases. Most respondents (89%) reported having at least 1 case in the last 3 years, with a total case experience of at least 785 cases (785 = the minimum number of cases in each case volume category x the number of respondents choosing that category). The strategy recommended in published guidelines, bivalirudin, was the most commonly reported alternative anticoagulation strategy (75%) used by respondents in HIT cases, with most (83%) using the activated clotting time (ACT) to monitor anticoagulation. CONCLUSIONS: Most responding SCA and AmSECT members reported that their institution used a protocol or guideline for HIT/CPB cases, and most guidelines directed the use of bivalirudin as an alternative anticoagulant. Various other methods such as plasmapheresis are also being used with success in this patient population. Further research, including comparison studies of alternative anticoagulant strategies, is required to elucidate the best approach to these difficult cases.
引用
收藏
页码:1180 / 1186
页数:7
相关论文
共 17 条
[1]  
Antoniou T, 2002, HEART SURG FORUM, V5, P354
[2]   Heparin-induced thrombocytopenia in surgical patients [J].
Battistelli, Sandra ;
Genovese, Alberto ;
Gori, Tommaso .
AMERICAN JOURNAL OF SURGERY, 2010, 199 (01) :43-51
[3]   Tissue factor as the main activator of the coagulation system during cardiopulmonary bypass [J].
De Somer, F ;
Van Belleghem, Y ;
Caes, F ;
François, K ;
Van Overbeke, H ;
Arnout, J ;
Taeymans, Y ;
Van Nooten, G .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2002, 123 (05) :951-958
[4]   A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: The EVOLUTION-ON study [J].
Dyke, CM ;
Smedira, NG ;
Koster, A ;
Aronson, S ;
McCarthy, HL ;
Kirshner, R ;
Lincoff, AM ;
Spiess, BD .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2006, 131 (03) :533-539
[5]   Successful use of argatroban as a heparin substitute during cardiopulmonary bypass: Heparin-induced thrombocytopenia in a high-risk cardiac surgical patient [J].
Edwards, JT ;
Hamby, JK ;
Worrall, NK .
ANNALS OF THORACIC SURGERY, 2003, 75 (05) :1622-1624
[6]   Heparin-Induced Thrombocytopenia: A Review for Cardiac Anesthesiologists and Intensivists [J].
Ivascu, Natalia S. ;
Fitzgerald, Meghann ;
Ghadimi, Kamrouz ;
Patel, Prakash ;
Evans, Adam S. ;
Goeddel, Lee A. ;
Shaefi, Shaz ;
Klick, John ;
Johnson, Angela ;
Raiten, Jesse ;
Horak, Jiri ;
Gutsche, Jacob .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2019, 33 (02) :511-520
[7]   Anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II and renal impairment using heparin and the platelet glycoprotein IIb-IIIa antagonist tirofiban [J].
Koster, A ;
Kulucka, M ;
Bach, F ;
Meyer, O ;
Fischer, T ;
Mertzlufft, F ;
Loebe, M ;
Hetzer, R ;
Kuppe, H .
ANESTHESIOLOGY, 2001, 94 (02) :245-251
[8]   Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: Results of the CHOOSE-ON trial [J].
Koster, Andreas ;
Dyke, Cornelius M. ;
Aldea, Gabriel ;
Smedira, Nicholas G. ;
McCarthy, Harry L., II ;
Aronson, Solomon ;
Hetzer, Roland ;
Avery, Edwin ;
Spiess, Bruce ;
Lincoff, A. Michael .
ANNALS OF THORACIC SURGERY, 2007, 83 (02) :572-577
[9]   Inflammatory response to cardiopulmonary bypass [J].
Levy, JH ;
Tanaka, KA .
ANNALS OF THORACIC SURGERY, 2003, 75 (02) :S715-S720
[10]   Treatment and Prevention of Heparin-Induced Thrombocytopenia Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [J].
Linkins, Lori-Ann ;
Dans, Antonio L. ;
Moores, Lisa K. ;
Bona, Robert ;
Davidson, Bruce L. ;
Schulman, Sam ;
Crowther, Mark .
CHEST, 2012, 141 (02) :E495S-E530S