Anticoagulation management for cardiopulmonary bypass (CPB) is challenging in patients with acute heparin-induced thrombocytopenia (HIT). The strategy of combining cangrelor intraoperatively with heparin for CPB anticoagulation is of increasing interest but exposes to specific unresolved problems.We report the case of a patient requiring surgical pulmonary embolectomy for pulmonary embolism at the very acute phase of HIT, with a high titre of anti-PF4/heparin antibodies and severe thrombocytopenia. For CPB management, cangrelor was administered in combination with heparin prescribed and monitored as usual. Surgery was successfully performed, but postoperatively, the patient developed a new thrombotic event. We discussed the specific problems associated with such strategy, including the dose of cangrelor and its monitoring, the management of the cell-saver, the risk of heparin rebound and the risk of platelet transfusion. These issues must be addressed before considering the combination of cangrelor and unfractionated heparin as a standard of care for CBP.
CITATION STYLE
Godier, A., Boucebci, K. J., Delhaye, N., Gendron, N., Achouh, P., & Hamada, S. R. (2023). Cangrelor for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia: it is not so easy. Blood Coagulation and Fibrinolysis, 34(3), 224–227. https://doi.org/10.1097/MBC.0000000000001193
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