Mayor incidencia de trombosis en pacientes con riesgo de trombocitopenia inducida por heparina que reciben epoprostenol en cirugía cardíaca

OBJECTIVE: Heparin-induced thrombocytopenia (HIT) is a serious concern in cardiac surgery, as heparin use in the at-risk patient can lead to devastating thrombosis. Management strategies for patients with confirmed or suspected HIT include using alternative anticoagulants, such as bivalirudin, but heparin administration in the presence of a potent antiplatelet agent, such as a prostacyclin analogue, has been reported as a safe approach. This retrospective study aimed to evaluate the incidence of thromboembolism in patients with confirmed or suspected HIT who received heparin with intravenous epoprostenol for anticoagulation during cardiac surgery. DESIGN: A single-center retrospective observational study. SETTING: An adult tertiary care referral center. PARTICIPANTS: Sixteen patients who underwent cardiac surgery between 2014 and 2024. All patients had a suspicion of HIT or confirmed HIT by testing. INTERVENTIONS: Patients presenting for cardiac surgery with confirmed or suspected HIT received heparin with intravenous epoprostenol intraoperatively according to an institutional protocol. MEASUREMENTS AND MAIN RESULTS: Collected data included preoperative testing for HIT antibody and serotonin release assay results, as well as whether a thromboembolic event was diagnosed postoperatively. Of the 9 patients who had a positive HIT antibody, 6 had a positive serotonin release assay. Of these 6 patients, 4 had a confirmed thromboembolic event (66.7%). CONCLUSIONS: The rate of thrombosis in our review was considerably higher than the published data on the use of prostacyclin analogues with heparin in patients with HIT, suggesting that this strategy may not be as effective for preventing thrombosis as previously thought. Until larger studies can be conducted, it may be in the best interest of patients with HIT for surgical teams to utilize alternative agents, such as bivalirudin, for anticoagulation in cardiac surgery.

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

El resumen se deja sin traducir para conservar la redacción original de los autores.

Estudio observacional retrospectivo unicéntrico con 16 pacientes con sospecha o confirmación de trombocitopenia inducida por heparina (2014-2024) que recibieron heparina con epoprostenol intravenoso en cirugía cardíaca. De 9 con anticuerpos positivos, 6 tuvieron prueba de liberación de serotonina positiva, y 4 de estos 6 presentaron un evento tromboembólico confirmado (66,7 %). La tasa de trombosis superó considerablemente lo publicado; los autores dudan de que la estrategia sea tan eficaz como se pensaba y sugieren alternativas como bivalirudina hasta estudios mayores.

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