Cangrelor for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia: it is not so easy. Issue 3 (18th April 2023)

• Record Type: Journal Article
• Authors: Godier, Anne; Boucebci, Karim-John; Delhaye, Nathalie; Gendron, Nicolas; Achouh, Paul; Hamada, Sophie Rym
• Is Part Of: Blood coagulation and fibrinolysis. Volume 34:Issue 3(2023)
• Page Start: 224
• Page End: 227
• Publication Date: 2023-04-18
• Subjects: cangrelor -- cardiopulmonary-bypass -- heparin-induced thrombocytopenia -- thrombosis; Blood -- Coagulation -- Periodicals; Fibrinolysis -- Periodicals; Hemostasis -- Periodicals; Thrombosis -- Periodicals; Blood Coagulation -- Periodicals; Fibrinolysis -- Periodicals; Hemostasis -- Periodicals; Thrombosis -- Periodicals; 612.115
• DOI: 10.1097/MBC.0000000000001193
• Languages: English
• ISSNs: 0957-5235

Abstract

Abstract : Anticoagulation management for cardiopulmonary bypass (CPB) is challenging in patients with acute heparin-induced thrombocytopenia (HIT). The strategy of combining cangrelor intraoperatively with heparin for CPB anticoagulation is of increasing interest but exposes to specific unresolved problems. We report the case of a patient requiring surgical pulmonary embolectomy for pulmonary embolism at the very acute phase of HIT, with a high titre of anti-PF4/heparin antibodies and severe thrombocytopenia. For CPB management, cangrelor was administered in combination with heparin prescribed and monitored as usual. Surgery was successfully performed, but postoperatively, the patient developed a new thrombotic event. We discussed the specific problems associated with such strategy, including the dose of cangrelor and its monitoring, the management of the cell-saver, the risk of heparin rebound and the risk of platelet transfusion. These issues must be addressed before considering the combination of cangrelor and unfractionated heparin as a standard of care for CBP.