التفاصيل البيبلوغرافية
| العنوان: |
How to Solve the Conundrum of Heparin-Induced Thrombocytopenia during Cardiopulmonary Bypass |
| المؤلفون: |
Etienne Revelly, Emmanuelle Scala, Lorenzo Rosner, Valentina Rancati, Ziyad Gunga, Matthias Kirsch, Zied Ltaief, Marco Rusca, Xavier Bechtold, Lorenzo Alberio, Carlo Marcucci |
| المصدر: |
Journal of Clinical Medicine; Volume 12; Issue 3; Pages: 786 |
| بيانات النشر: |
Multidisciplinary Digital Publishing Institute |
| سنة النشر: |
2023 |
| المجموعة: |
MDPI Open Access Publishing |
| مصطلحات موضوعية: |
cardiac surgery, cardiopulmonary bypass, intraoperative management, heparin-induced thrombocytopenia syndrome, direct thrombin inhibitor, antiplatelet therapy |
| الوصف: |
Heparin-induced thrombocytopenia (HIT) is a major issue in cardiac surgery requiring cardiopulmonary bypass (CPB). HIT represents a severe adverse drug reaction after heparin administration. It consists of immune-mediated thrombocytopenia paradoxically leading to thrombotic events. Detection of antibodies against platelets factor 4/heparin (anti-PF4/H) and aggregation of platelets in the presence of heparin in functional in vitro tests confirm the diagnosis. Patients suffering from HIT and requiring cardiac surgery are at high risk of lethal complications and present specific challenges. Four distinct phases are described in the usual HIT timeline, and the anticoagulation strategy chosen for CPB depends on the phase in which the patient is categorized. In this sense, we developed an institutional protocol covering each phase. It consisted of the use of a non-heparin anticoagulant such as bivalirudin, or the association of unfractionated heparin (UFH) with a potent antiplatelet drug such as tirofiban or cangrelor. Temporary reduction of anti-PF4 with intravenous immunoglobulins (IvIg) has recently been described as a complementary strategy. In this article, we briefly described the pathophysiology of HIT and focused on the various strategies that can be applied to safely manage CPB in these patients. |
| نوع الوثيقة: |
text |
| وصف الملف: |
application/pdf |
| اللغة: |
English |
| العلاقة: |
Intensive Care; https://dx.doi.org/10.3390/jcm12030786Test |
| DOI: |
10.3390/jcm12030786 |
| الإتاحة: |
https://doi.org/10.3390/jcm12030786Test |
| حقوق: |
https://creativecommons.org/licenses/by/4.0Test/ |
| رقم الانضمام: |
edsbas.A413D1C |
| قاعدة البيانات: |
BASE |
