Nonheparin anticoagulants used during cardiac surgery in HIT
| Author/Year (N) study type . | Population (n) . | Surgery (n) . | Nonheparin anticoagulant and mean dose . | Outcomes . |
|---|---|---|---|---|
| Fernandes 200017 (6) Retrospective CS | HIT Ab + (3) HIT Ab + SRA + (1) HIT Ab − (2) | OHT (1) MVR (1) CABG (4) | Danaparoid bolus +/−7 u/kg/h infusion to target anti-Xa of 1.5-2.0 units/mL | Fibrin strands in operative field and/or CPB circuit in 50% Postop stroke in 1 patient Postop blood loss 330-3250 mL |
| Koster 200018 (57) Retrospective CS | HIT Ab + (6) HIPAA + (46) Remote HIT (5) | CABG (27) Valve surgery (16) CABG + valve surgery (8) Aneurysm repair (4) Other (2) | Hirudin 0.25 mg/kg intravenous bolus followed by a continuous infusion of 0.5 mg/min | 24-hour blood loss 50-2200 mL CPB clotting in 2 patients 3 unrelated deaths |
| Koster 200710 (49) Prospective single-arm study | HIT Ab + (35) HIT Ab & functional assay + (7) Clinical HIT with Tpenia (1) Remote HIT (6) | On-pump CABG | Bivalirudin 1 mg/kg + 2.5 mg/kg/h | Procedural success = 94%a Intraop blood loss: 575 ± 524 mL (50-1900) 24-h blood loss = 936 ± 525 mL (600-2745) |
| Dyke 200711 (51)b Prospective single-arm study | HIT Ab + (35) HIT Ab + and Tpenia (6) Tpenia only (5) HIT + thrombosis (5) HIT not confirmed (1) | Off-pump CABG | Bivalirudin 0.75 mg/kg + 1.75 mg/kg/h | Procedural success = 92%a Intraop blood loss: 404 ± 420 mL (50-2140) 24-h blood loss = 998 ± 595 mL (100-3200) |
| Author/Year (N) study type . | Population (n) . | Surgery (n) . | Nonheparin anticoagulant and mean dose . | Outcomes . |
|---|---|---|---|---|
| Fernandes 200017 (6) Retrospective CS | HIT Ab + (3) HIT Ab + SRA + (1) HIT Ab − (2) | OHT (1) MVR (1) CABG (4) | Danaparoid bolus +/−7 u/kg/h infusion to target anti-Xa of 1.5-2.0 units/mL | Fibrin strands in operative field and/or CPB circuit in 50% Postop stroke in 1 patient Postop blood loss 330-3250 mL |
| Koster 200018 (57) Retrospective CS | HIT Ab + (6) HIPAA + (46) Remote HIT (5) | CABG (27) Valve surgery (16) CABG + valve surgery (8) Aneurysm repair (4) Other (2) | Hirudin 0.25 mg/kg intravenous bolus followed by a continuous infusion of 0.5 mg/min | 24-hour blood loss 50-2200 mL CPB clotting in 2 patients 3 unrelated deaths |
| Koster 200710 (49) Prospective single-arm study | HIT Ab + (35) HIT Ab & functional assay + (7) Clinical HIT with Tpenia (1) Remote HIT (6) | On-pump CABG | Bivalirudin 1 mg/kg + 2.5 mg/kg/h | Procedural success = 94%a Intraop blood loss: 575 ± 524 mL (50-1900) 24-h blood loss = 936 ± 525 mL (600-2745) |
| Dyke 200711 (51)b Prospective single-arm study | HIT Ab + (35) HIT Ab + and Tpenia (6) Tpenia only (5) HIT + thrombosis (5) HIT not confirmed (1) | Off-pump CABG | Bivalirudin 0.75 mg/kg + 1.75 mg/kg/h | Procedural success = 92%a Intraop blood loss: 404 ± 420 mL (50-2140) 24-h blood loss = 998 ± 595 mL (100-3200) |
Procedural success was defined as the absence of death, myocardial infarction, stroke, or repeat revascularization by postoperative day 7 or hospital discharge, whichever occurred first.
Although only 51 patients are in the study, the total number of HIT diagnoses adds up to 52.
Abs, antibodies; CABG, coronary artery bypass grafting; CS, case series; CPB, cardiopulmonary bypass; OHT, orthotopic heart transplant; Tpenia, thrombocytopenia.