American Society of Hirudotherapy

Management of anticoagulation in patients with subacute heparin-induced thrombocytopenia scheduled for heart transplantation

Clinical perspective published in Blood (2008)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportClinical LiteratureDrug DevelopmentSelleng S et al. · Blood, 2008

Abstract

Anticoagulation management of patients with recent heparin-induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB) surgery is a serious challenge, and especially difficult in patients requiring urgent heart transplantation. As nonheparin anticoagulants during CPB bear a high risk of major bleeding, these patients are at risk of being taken off the transplant list. Short-term use of unfractionated heparin (UFH) for CPB, with restriction of UFH to the surgery itself, is safe and effective in patients with a history of HIT who test negative for antiplatelet factor 4 (PF4)/heparin antibodies. We present evidence that it is safe to expand the concept of UFH reexposure to patients with subacute HIT (ie, those patients with recent HIT in whom the platelet count has recovered but in whom anti-PF4/heparin IgG antibodies remain detectable) requiring heart transplantation, if they test negative by a sensitive functional assay using washed platelets. This can be lifesaving in patients with end-stage heart failure.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeCase ReportsJournal Article
Indexed MeSH termsAdultAnticoagulantsArginineAutoantibodiesHeart FailureHeart TransplantationHeparinHirudinsHumansMaleMiddle AgedPipecolic AcidsPlatelet Factor 4Recombinant ProteinsSulfonamidesThrombocytopenia

Summary

Demonstrates safety of restricted intraoperative heparin re-exposure (rather than alternative non-heparin anticoagulants with high bleeding risk) for heart-transplant patients with recent HIT testing negative on washed-platelet functional assays.

Context

This article presents evidence on anticoagulation management in patients with subacute heparin-induced thrombocytopenia (HIT)—defined as recent HIT with recovered platelet counts but persistently detectable anti-PF4/heparin IgG antibodies—requiring heart transplantation. The authors argue that short-term unfractionated heparin (UFH), restricted to cardiopulmonary bypass surgery itself, can be safely administered in subacute HIT patients who test negative on a sensitive functional assay using washed platelets, potentially lifesaving in end-stage heart failure. This abstract contains no mention of hirudin, leeches, hirudotherapy, or the leech secretome. The study addresses perioperative anticoagulation strategy in transplant surgery.

Citation

Reference (Vancouver style)

Selleng S, Haneya A, Hirt S, Selleng K, Schmid C, Greinacher A. Management of anticoagulation in patients with subacute heparin-induced thrombocytopenia scheduled for heart transplantation. Blood. 2008;112(10):4024-4027. doi:10.1182/blood-2008-03-145243. PMID: 18791163

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

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