Antiplatelet agents for unfractionated heparin reexposure in HIT
| Author/Year (N) study type . | Population (n) . | Surgery (n) . | Antiplatelet agent and mean dose . | Outcomes . |
|---|---|---|---|---|
| Koster 200129 (47) Retrospective CS | HIPA + (35) Remote HIT (12) | Aortic surgery, transplant, reoperation, combined proceduresa | bTirofiban 10 µg/kg bolus + 0.15 µg/kg infusion | 24-h mean postop blood loss 410 ± 180 mL |
| Palatianos 201514 (110) Retrospective case control | HIT Ab + (64) HIT Ab + & Tpenia (46) | CABG (74) valve replacement (49) AAA (12) | cIloprost 7.63 ng/kg/min (range, 3–24) | No significant differences from 118 HIT negative controls |
| Lee 201816 (6) Retrospective CS | HIT Ab & SRA + (2) HIT Ab + SRA NR (2) HIT Ab + SRA − (2) | VAD (6) | dAbciximab 0.25 mg/kg bolus + 0.125 ug/kg | Median postop ICU stay = 9 days (range 5-76); hospital stay = 22 days (range 18-132) |
| Gernhofer 20194 (10) Retrospective CS | HIT Ab & SRA + (3) HIT Ab + SRA − (4) HIT Ab + no SRA (1) HIT Ab – (1) Remote HIT – no testing (1) | AVR (1) Pulmonary TE (6) OHT (1) VAD (2) | eCangrelor 30 µg/kg bolus + 2–4 µg/kg/min | No thrombotic events. One death in a patient with advanced intracardiac malignancy. |
| Author/Year (N) study type . | Population (n) . | Surgery (n) . | Antiplatelet agent and mean dose . | Outcomes . |
|---|---|---|---|---|
| Koster 200129 (47) Retrospective CS | HIPA + (35) Remote HIT (12) | Aortic surgery, transplant, reoperation, combined proceduresa | bTirofiban 10 µg/kg bolus + 0.15 µg/kg infusion | 24-h mean postop blood loss 410 ± 180 mL |
| Palatianos 201514 (110) Retrospective case control | HIT Ab + (64) HIT Ab + & Tpenia (46) | CABG (74) valve replacement (49) AAA (12) | cIloprost 7.63 ng/kg/min (range, 3–24) | No significant differences from 118 HIT negative controls |
| Lee 201816 (6) Retrospective CS | HIT Ab & SRA + (2) HIT Ab + SRA NR (2) HIT Ab + SRA − (2) | VAD (6) | dAbciximab 0.25 mg/kg bolus + 0.125 ug/kg | Median postop ICU stay = 9 days (range 5-76); hospital stay = 22 days (range 18-132) |
| Gernhofer 20194 (10) Retrospective CS | HIT Ab & SRA + (3) HIT Ab + SRA − (4) HIT Ab + no SRA (1) HIT Ab – (1) Remote HIT – no testing (1) | AVR (1) Pulmonary TE (6) OHT (1) VAD (2) | eCangrelor 30 µg/kg bolus + 2–4 µg/kg/min | No thrombotic events. One death in a patient with advanced intracardiac malignancy. |
The types of surgery were not specified.
Tirofiban was administered 10 minutes prior to heparin.
Iloprost target dose was initially determined based on the dose that diminished the heparin-induced platelet aggregation assay to less than 5%.
Abciximab was followed by heparin, 3 minutes later, prior to cardiopulmonary bypass.
Cangrelor infusion rate was adjusted to the P2Y12 reaction unit (PRU) values throughout CPB. After cangrelor achieved satisfactory platelet inhibition, heparin was administered 10 minutes later.
AAA, aortic abdominal aneurysm repair; Ab, antibody; AVR, aortic valve replacement; CABG, coronary artery bypass grafting; CS, case series; HIPA, heparin-induced platelet aggregation; OHT, orthotopic heart transplant; TE, thromboendarterectomy; Tpenia, thrombocytopenia; VAD, ventricular assist device.