A Patient With Remote Heparin-Induced Thrombocytopenia and Antiphospholipid Syndrome Requiring Cardiopulmonary Bypass: Do Current Guidelines Apply?
Case report published in Semin Cardiothorac Vasc Anesth (2018)
Abstract
Anticoagulation for cardiopulmonary bypass (CPB) is required to prevent acute disseminated intravascular coagulation and clot formation within the bypass circuit. Unfractionated heparin is the standard anticoagulant for CPB due to its many advantages and long history of successful use. However, heparin has the unique drawback of triggering Heparin-PF4 (PF4) antibodies potentially leading to heparin-induced thrombocytopenia (HIT). We have limited data regarding reformation of antibodies if a patient has had a prior (remote) antibody production or full HIT. Patients with antiphospholipid antibodies undergoing CPB with unfractionated heparin have a high complication rate, even in the absence of HIT. Antiphospholipid antibodies have a multifaceted, cumulatively inhibitory effect on the normal anticoagulation armamentarium in vivo. Even more concerning is the possibility that antiphospholipid syndrome and HIT may be synergistic. We report a patient with risk factors for both thromboembolic (remote history of HIT and antiphospholipid syndrome) and hemorrhagic complications who underwent an aortic valve replacement and coronary artery bypass grafting on CPB using bivalirudin. We discuss the complex decision making regarding anticoagulant for CPB, particularly with regard to American College of Chest Physicians guidelines.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Case using bivalirudin for cardiopulmonary bypass in patient with remote HIT and antiphospholipid syndrome undergoing aortic valve replacement and CABG.
Por qué esto importa para la hirudoterapia
Este reporte de caso describe a un paciente con trombocitopenia inducida por heparina (TIH) remota y síndrome antifosfolipídico, sometido a reemplazo valvular aórtico e injerto de derivación coronaria bajo circulación extracorpórea, para lo cual se utilizó bivalirudina como anticoagulante en lugar de la heparina no fraccionada convencional. Esto es directamente relevante para la hirudoterapia y el secretoma de la sanguijuela porque la bivalirudina es un inhibidor directo de la trombina modelado a partir de la hirudina, el anticoagulante aislado originalmente de la saliva de la sanguijuela medicinal, lo que ilustra cómo un principio farmacológico derivado de la sanguijuela continúa dando respuesta a retos clínicos reales cuando la anticoagulación convencional basada en heparina está contraindicada. Los autores comentan la toma de decisiones complejas sobre anticoagulación a la luz de las guías del American College of Chest Physicians. No obstante, al tratarse de un reporte de un único caso, no se establece la eficacia ni la seguridad más amplia de la bivalirudina en este contexto, y el manejo reflejó los factores de riesgo trombóticos y hemorrágicos combinados de este paciente en particular.
Citación
A Patient With Remote Heparin-Induced Thrombocytopenia and Antiphospholipid Syndrome Requiring Cardiopulmonary Bypass: Do Current Guidelines Apply?.
Ibrahim W et al. · Semin Cardiothorac Vasc Anesth, 2018
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026