Treating Heparin-Induced Thrombocytopenia in Patients Undergoing HeartMate 3 Left Ventricular Assist Device Implantation
Review published in The Israel Medical Association journal : IMAJ (2023)
Abstract
BACKGROUND: Unfractionated heparin is the preferred anticoagulant used during open heart surgeries, including left ventricular assist device (LVAD) implantation. In cases in which patients are heparin-induced thrombocytopenia positive (HIT+), the accepted practice has been to substitute heparin with bivalirudin. This practice may be associated with significant bleeding and adverse outcomes. OBJECTIVES: To review our experience with HIT+ patients who were heparin-induced thrombocytopenia with thrombosis negative (HITT-) and who underwent HeartMate 3 LVAD implantation using heparin intraoperatively rather than bivalirudin. METHODS: From 2016 to 2022, 144 adult patients were implanted with HeartMate 3 LVAD at our center. Among them, 7 were detected as HIT+ but HITT- and therefore were prescribed intraoperatively with heparin and treated pre- and postoperatively with bivalirudin. We reviewed the preoperative, intraoperative, and postoperative characteristics as well as short-term mortality and the complication rates of these HIT+ patients. RESULTS: The median age of our cohort was 56 years (51-60), 71% were male (n=5), all were INTERMACS Level 1, and most were bridged to transplant (n=6, 86%). The 30-day mortality rate post-implantation was 0%. The average 24-hour chest drain postoperative output was 1502.86 ± 931.34 ml. There were no intraoperative pump thromboses, perioperative thromboses, cerebrovascular accidents, or gastrointestinal bleeding within the first 24 hours postoperative. One patient required a revision due to bleeding. CONCLUSIONS: Intraoperative unfractionated heparin may be administered to patients who are HIT+ and HITT- while undergoing LVAD implantation. However, further investigation is required.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Unfractionated heparin is the preferred anticoagulant used during open heart surgeries, including left ventricular assist device (LVAD) implantation.
Por qué esto importa para la hirudoterapia
Esta serie de casos unicéntrica revisó 7 pacientes que eran positivos para trombocitopenia inducida por heparina pero negativos para trombosis (HITT-) y fueron sometidos a implantación de LVAD HeartMate 3 utilizando heparina no fraccionada intraoperatoria con bivalirudina pre- y postoperatoria, reportando 0% de mortalidad a 30 días, ninguna trombosis perioperatoria y una reintervención relacionada con sangrado. El estudio es relevante para la ASH/hirudoterapia porque la bivalirudina es un inhibidor directo de la trombina modelado a partir de la hirudina del secretoma de la sanguijuela medicinal, y los datos clínicos sobre su uso perioperatorio en cirugía cardíaca de alto riesgo informan directamente sobre el rendimiento de los anticoagulantes de clase hirudina en la práctica. Los hallazgos sugieren una estrategia potencial para limitar la exposición intraoperatoria a bivalirudina en este contexto; sin embargo, el tamaño muestral muy pequeño (n=7), el diseño observacional, la experiencia unicéntrica y el seguimiento breve hacen que los resultados solo generen hipótesis, sin demostrar eficacia ni seguridad.
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026