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Cardiac Surgery Successfully Managed With Cangrelor in a Patient With Persistent Anti-PF4/Heparin Antibodies 8 Years After Heparin-Induced Thrombocytopenia.
J Cardiothorac Vasc Anesth 2019; 33(11):3073-3077JC

Abstract

A 66-YEAR-OLD female requiring cardiac surgery had persisting anti-platelet factor 4 (PF4)/heparin antibodies (HIT-abs) 8 years after heparin-induced thrombocytopenia (HIT). In 2010, she developed thrombotic thrombocytopenic purpura (TTP) (ADAMTS-13 <5%, inhibitor at 1.0 BU/mL), which was treated successfully with corticotherapy, plasmapheresis, and intravenous heparin. While taking heparin, she developed HIT, as evidenced by a positive functional test. Her platelet count fully resolved without thrombotic complications with danaparoid treatment. In 2018, the preoperative titer of HIT-abs was still 0.38 U/mL by chemoluminescent immunoassay (CLIA), and positive by particle-gel agglutination immunoassay (PaGIA) with a titer of 2 and was strongly positive on an enzyme-linked immunosorbent assay (ELISA). The authors of the case report chose to use cangrelor combined with heparin during cardiopulmonary bypass (CPB). Cangrelor was used without increased postoperative bleeding or thrombotic complications. Postoperatively she exhibited a huge rise in HIT-abs (14.22 U/mL on postoperative day 11) with a positive functional assay. There was no recurrence of HIT, however. This case illustrates the importance of excluding the presence of persisting HIT-abs before CPB and ensuring close medical follow-up after even a single exposure to heparin.

Authors+Show Affiliations

Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland. Electronic address: Emmanuelle.Scala@chuv.ch.Department of Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.Department of Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland.Department of Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.Department of Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31420311

Citation

Scala, Emmanuelle, et al. "Cardiac Surgery Successfully Managed With Cangrelor in a Patient With Persistent Anti-PF4/Heparin Antibodies 8 Years After Heparin-Induced Thrombocytopenia." Journal of Cardiothoracic and Vascular Anesthesia, vol. 33, no. 11, 2019, pp. 3073-3077.
Scala E, Pitta-Gros B, Pantet O, et al. Cardiac Surgery Successfully Managed With Cangrelor in a Patient With Persistent Anti-PF4/Heparin Antibodies 8 Years After Heparin-Induced Thrombocytopenia. J Cardiothorac Vasc Anesth. 2019;33(11):3073-3077.
Scala, E., Pitta-Gros, B., Pantet, O., Iafrate, M., Kirsch, M., Marcucci, C., & Alberio, L. (2019). Cardiac Surgery Successfully Managed With Cangrelor in a Patient With Persistent Anti-PF4/Heparin Antibodies 8 Years After Heparin-Induced Thrombocytopenia. Journal of Cardiothoracic and Vascular Anesthesia, 33(11), pp. 3073-3077. doi:10.1053/j.jvca.2019.06.044.
Scala E, et al. Cardiac Surgery Successfully Managed With Cangrelor in a Patient With Persistent Anti-PF4/Heparin Antibodies 8 Years After Heparin-Induced Thrombocytopenia. J Cardiothorac Vasc Anesth. 2019;33(11):3073-3077. PubMed PMID: 31420311.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiac Surgery Successfully Managed With Cangrelor in a Patient With Persistent Anti-PF4/Heparin Antibodies 8 Years After Heparin-Induced Thrombocytopenia. AU - Scala,Emmanuelle, AU - Pitta-Gros,Barbara, AU - Pantet,Olivier, AU - Iafrate,Manuel, AU - Kirsch,Matthias, AU - Marcucci,Carlo, AU - Alberio,Lorenzo, Y1 - 2019/07/06/ PY - 2019/05/24/received PY - 2019/06/28/revised PY - 2019/06/30/accepted PY - 2019/8/20/pubmed PY - 2019/8/20/medline PY - 2019/8/18/entrez KW - cangrelor KW - cardiac surgery KW - heparin-induced thrombocytopenia KW - platelet SP - 3073 EP - 3077 JF - Journal of cardiothoracic and vascular anesthesia JO - J. Cardiothorac. Vasc. Anesth. VL - 33 IS - 11 N2 - A 66-YEAR-OLD female requiring cardiac surgery had persisting anti-platelet factor 4 (PF4)/heparin antibodies (HIT-abs) 8 years after heparin-induced thrombocytopenia (HIT). In 2010, she developed thrombotic thrombocytopenic purpura (TTP) (ADAMTS-13 <5%, inhibitor at 1.0 BU/mL), which was treated successfully with corticotherapy, plasmapheresis, and intravenous heparin. While taking heparin, she developed HIT, as evidenced by a positive functional test. Her platelet count fully resolved without thrombotic complications with danaparoid treatment. In 2018, the preoperative titer of HIT-abs was still 0.38 U/mL by chemoluminescent immunoassay (CLIA), and positive by particle-gel agglutination immunoassay (PaGIA) with a titer of 2 and was strongly positive on an enzyme-linked immunosorbent assay (ELISA). The authors of the case report chose to use cangrelor combined with heparin during cardiopulmonary bypass (CPB). Cangrelor was used without increased postoperative bleeding or thrombotic complications. Postoperatively she exhibited a huge rise in HIT-abs (14.22 U/mL on postoperative day 11) with a positive functional assay. There was no recurrence of HIT, however. This case illustrates the importance of excluding the presence of persisting HIT-abs before CPB and ensuring close medical follow-up after even a single exposure to heparin. SN - 1532-8422 UR - https://www.unboundmedicine.com/medline/citation/31420311/Cardiac_Surgery_Successfully_Managed_With_Cangrelor_in_a_Patient_With_Persistent_Anti-PF4/Heparin_Antibodies_8_Years_After_Heparin-Induced_Thrombocytopenia L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(19)30636-6 DB - PRIME DP - Unbound Medicine ER -