Off-pump coronary artery bypass with heparin in a patient with a history of heparin-induced thrombocytopenia: a case report
Abstract Background Cardiovascular surgery for patients with a history of heparin-induced thrombocytopenia (HIT) with thrombosis requires careful perioperative anticoagulation therapy. When cardiovascular surgery is required for patients having ‘remote’ HIT, such as those who had a history of HIT an...
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Japan Surgical Society
2021-12-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-021-01339-9 |
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| author | Yuya Ito Aya Saito Yuki Shirai Noboru Motomura |
| author_facet | Yuya Ito Aya Saito Yuki Shirai Noboru Motomura |
| author_sort | Yuya Ito |
| collection | DOAJ |
| description | Abstract Background Cardiovascular surgery for patients with a history of heparin-induced thrombocytopenia (HIT) with thrombosis requires careful perioperative anticoagulation therapy. When cardiovascular surgery is required for patients having ‘remote’ HIT, such as those who had a history of HIT and platelet factor-4/heparin antibodies turned out to be negative, it is recommended that re-exposure to heparin should be limited only to the intraoperative phase. However, few case reports have described detailed strategies for perioperative anticoagulation regimens. Case presentation We present the case of a 76-year-old woman, presenting with unstable angina pectoris and requiring coronary artery bypass grafting. She had a history of cardiac resuscitation and percutaneous coronary intervention for unstable angina pectoris with ventricular tachycardia 7 years prior, which caused HIT with thrombosis resulting in amputation of four fingers. On admission, platelet factor-4/heparin antibodies, biomarkers for HIT were not detected; the platelet count was 18.0 × 104/µl. Off-pump coronary artery bypass grafting was performed using heparin; argatroban infusion was continued until 9 h prior to the operation and restarted 3 h postoperatively, bridged with regular warfarin from 4 days to 3 months postoperatively. Platelet factor-4 /heparin antibodies were detected on postoperative day 8 without any clinical symptoms and became negative by day 91. Conclusion We consider this anticoagulation strategy is effective especially in countries, where bivalirudin is not available. Re-exposure to heparin in cardiovascular surgery for patients with a history of ‘remote HIT’ is reasonable, and appropriate anticoagulation is important for an uneventful postoperative course. |
| format | Article |
| id | doaj-art-450f536ef54849068f8784a9af739b59 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-450f536ef54849068f8784a9af739b592025-08-20T03:34:29ZengJapan Surgical SocietySurgical Case Reports2198-77932021-12-01711410.1186/s40792-021-01339-9Off-pump coronary artery bypass with heparin in a patient with a history of heparin-induced thrombocytopenia: a case reportYuya Ito0Aya Saito1Yuki Shirai2Noboru Motomura3Department of Cardiovascular Surgery, Toho University Sakura Medical CenterDepartment of Cardiovascular Surgery, Toho University Sakura Medical CenterDepartment of Cardiovascular Surgery, Toho University Sakura Medical CenterDepartment of Cardiovascular Surgery, Toho University Sakura Medical CenterAbstract Background Cardiovascular surgery for patients with a history of heparin-induced thrombocytopenia (HIT) with thrombosis requires careful perioperative anticoagulation therapy. When cardiovascular surgery is required for patients having ‘remote’ HIT, such as those who had a history of HIT and platelet factor-4/heparin antibodies turned out to be negative, it is recommended that re-exposure to heparin should be limited only to the intraoperative phase. However, few case reports have described detailed strategies for perioperative anticoagulation regimens. Case presentation We present the case of a 76-year-old woman, presenting with unstable angina pectoris and requiring coronary artery bypass grafting. She had a history of cardiac resuscitation and percutaneous coronary intervention for unstable angina pectoris with ventricular tachycardia 7 years prior, which caused HIT with thrombosis resulting in amputation of four fingers. On admission, platelet factor-4/heparin antibodies, biomarkers for HIT were not detected; the platelet count was 18.0 × 104/µl. Off-pump coronary artery bypass grafting was performed using heparin; argatroban infusion was continued until 9 h prior to the operation and restarted 3 h postoperatively, bridged with regular warfarin from 4 days to 3 months postoperatively. Platelet factor-4 /heparin antibodies were detected on postoperative day 8 without any clinical symptoms and became negative by day 91. Conclusion We consider this anticoagulation strategy is effective especially in countries, where bivalirudin is not available. Re-exposure to heparin in cardiovascular surgery for patients with a history of ‘remote HIT’ is reasonable, and appropriate anticoagulation is important for an uneventful postoperative course.https://doi.org/10.1186/s40792-021-01339-9Coronary Artery Bypass GraftingHeparinThrombocytopeniaArgatrobanAngina Pectoris |
| spellingShingle | Yuya Ito Aya Saito Yuki Shirai Noboru Motomura Off-pump coronary artery bypass with heparin in a patient with a history of heparin-induced thrombocytopenia: a case report Surgical Case Reports Coronary Artery Bypass Grafting Heparin Thrombocytopenia Argatroban Angina Pectoris |
| title | Off-pump coronary artery bypass with heparin in a patient with a history of heparin-induced thrombocytopenia: a case report |
| title_full | Off-pump coronary artery bypass with heparin in a patient with a history of heparin-induced thrombocytopenia: a case report |
| title_fullStr | Off-pump coronary artery bypass with heparin in a patient with a history of heparin-induced thrombocytopenia: a case report |
| title_full_unstemmed | Off-pump coronary artery bypass with heparin in a patient with a history of heparin-induced thrombocytopenia: a case report |
| title_short | Off-pump coronary artery bypass with heparin in a patient with a history of heparin-induced thrombocytopenia: a case report |
| title_sort | off pump coronary artery bypass with heparin in a patient with a history of heparin induced thrombocytopenia a case report |
| topic | Coronary Artery Bypass Grafting Heparin Thrombocytopenia Argatroban Angina Pectoris |
| url | https://doi.org/10.1186/s40792-021-01339-9 |
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