Cardiopulmonary Bypass Without Heparin.
Review published in Seminars in cardiothoracic and vascular anesthesia (2016)
Abstract
Due to familiarity, short half-life, ease of monitoring, and the availability of a reversal agent, heparin remains the anticoagulant of choice for cardiac operations requiring cardiopulmonary bypass (CPB). However, occasionally patients require CPB but should not receive heparin, most often because of acute or subacute heparin-induced thrombocytopenia (HIT). In these cases, if it is not feasible to wait for the disappearance of HIT antibodies, an alternative anticoagulant must be selected. A number of non-heparin anticoagulant options have been explored. However, current recommendations suggest the use of a direct thrombin inhibitor such as bivalirudin. This review describes the use of heparin alternatives for the conduct of CPB with a focus on the direct thrombin inhibitors.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Due to familiarity, short half-life, ease of monitoring, and the availability of a reversal agent, heparin remains the anticoagulant of choice for cardiac operations requiring cardiopulmonary bypass (CPB). However, occasionally patients require CPB but should not receive heparin, most often because...
Why This Matters for Hirudotherapy
This review examines alternative anticoagulants to heparin for cardiopulmonary bypass, focusing on direct thrombin inhibitors such as bivalirudin for patients who cannot receive heparin (e.g., due to heparin-induced thrombocytopenia). The discussion of direct thrombin inhibitors is tangentially relevant to ASH's domain because hirudin, the archetypal leech-derived anticoagulant, shares the same drug class and mechanistic lineage. However, the article does not mention leeches, hirudin, or hirudotherapy at all, and its clinical scope (cardiac surgery anticoagulation) is far removed from leech therapy applications. Relevance is therefore purely conceptual and indirect — it provides background on the pharmacological family to which a leech-derived compound belongs.
Citation
Cardiopulmonary Bypass Without Heparin.
Rehfeldt et al. · Seminars in cardiothoracic and vascular anesthesia, 2016
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