Heparin Anticoagulation during Cardiopulmonary Bypass for Thoracoabdominal Aorta Replacement in a Patient with a History of Heparin-Induced Thrombocytopenia

(Department of Cardiovascular Surgery, Chiba Cardiovascular Center, Ichihara, Japan, and Division of Transfusion Medicine, National Cardiovascular Center*, Osaka, Japan)

Masanao Ohba Hirokazu Murayama Hiroyuki Kito
Kozo Matsuo Naoki Hayashida Souichi Asano
Masao Hirano Shigeki Miyata*
Immune heparin-induced thrombocytopenia(HIT)is a crucial side effect of heparin therapy. We report the case of a 52-year-old man who was strongly suspected of having HIT after urgent descending aorta replacement. This case required continuous hemodiafiltration(CHDF)anticoagulated with unfractionated heparin(UFH)for acute renal failure after the operation. The patient developed thrombocytopenia and thrombus emphraxis in the circuit on the seventh day and was suspected of having HIT. UFH was ceased and replaced with argatroban. After then, thrombus emphraxis was not seen in the circuit and the platelet count was recovered promptly. He tested positive in an enzyme-linked immunosorbent assay for anti-platelet factor 4/heparin antibodies(anti-PF4/H Abs). Six months later, we found, an expanding thoracoabdominal aortic aneurysm and performed thoracoabdominal aorta replacement. We selected heparin anticoagulation for cardiopulmonary bypass because anti-PF4/H Abs were negative at that time. Thrombus emphraxis was not found during the operation. The patient developed neither thrombocytopenia nor thrombosis in the perioperative period.
  Jpn. J. Cardiovasc. Surg. 39:144-147(2010)

Keywords:heparin-induced thrombocytopenia(HIT), cardiopulmonary bypass, thoracoabdominal aortic replacement