The use of direct thrombin inhibitors in cardiovascular surgery in patients with heparin-induced thrombocytopenia.
Research article published in Seminars in thrombosis and hemostasis (2004)
Abstract
One of the most important adverse drug reactions that physicians encounter is the life- and limb-threatening prothrombotic syndrome known as heparin-induced thrombocytopenia (HIT). Unfractionated heparin (UFH), administered during cardiopulmonary bypass (CPB), is highly immunogenic. Heparin-dependent antibodies can develop in 25 to 50% of UFH-treated cardiac surgery patients within 5 to 10 days. These antibodies can activate platelets and are considered the causative agents of HIT. HIT is a relatively common complication, occurring in 1 to 3% of cardiovascular surgery patients when UFH administration is continued postoperatively. It is strongly associated with new thromboembolic events leading to limb amputation and death. In acute or recent (< 100 days) HIT, alternative anticoagulatory regimens are needed during CPB surgery for prevention of HIT-related thrombosis. Treatment options for such patients now generally include the use of alternative anticoagulants such as lepirudin, bivalirudin, or danaparoid, as well as a combined treatment with platelet-function inhibitors and heparin. In patients with a history of HIT and no detectable antibodies, heparin is currently the safest approach for high-dose anticoagulation during CPB. Before and after surgery, however, alternative anticoagulants should be used. The risk of clinical HIT after heart surgery could potentially be reduced by using low-molecular-weight heparins for postsurgery anticoagulation.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
The use of direct thrombin inhibitors in cardiovascular surgery in patients with heparin-induced thrombocytopenia.
Por qué esto importa para la hirudoterapia
Esta revisión examina el manejo de la trombocitopenia inducida por heparina (TIH) en cirugía cardiovascular, donde la TIH ocurre en el 1–3% de los pacientes que reciben heparina no fraccionada en el postoperatorio y está fuertemente asociada con nuevos eventos tromboembólicos que conducen a amputación de extremidades y muerte. El artículo analiza la lepirudina (hirudina recombinante) junto con bivalirudina y danaparoide como anticoagulantes alternativos para pacientes que requieren derivación cardiopulmonar y que presentan TIH aguda o reciente, y recomienda la heparina para pacientes con antecedente de TIH pero sin anticuerpos detectables. Esta revisión es relevante para el ámbito de la ASH porque posiciona a la lepirudina — un anticoagulante directo derivado de la sanguijuela — como una opción terapéutica importante en una población quirúrgica de alto riesgo. Sin embargo, se trata de una revisión sin datos originales, y la lepirudina es una de varias alternativas analizadas en lugar de ser el foco exclusivo.
Citación
The use of direct thrombin inhibitors in cardiovascular surgery in patients with heparin-induced thrombocytopenia.
Greinacher · Seminars in thrombosis and hemostasis, 2004
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026