Cardiac surgery with cardiopulmonary bypass in patients with type II heparin-induced thrombocytopenia

Background. The use of cardiopulmonary bypass (CPB) in patients with a history of type II heparin-induced thrombocytopenia (HIT) may be associated with complications related to their anticoagulation management. Methods. Between January 1997 and December 1999, among 4,850 adults patients who underwent cardiac surgery in our institution, 10 patients presented with preoperative type II HIT. In 4 patients, anticoagulation during CPB was achieved with danaparoid sodium. In 6 other patients, heparin sodium was used after pretreatment with epoprostenol sodium. Results. No significant change in platelet count occurred in any patient. No intraoperative thrombotic complication was encountered. Total postoperative chest drainage ranged from 250 to 1,100 mi in patients pretreated with epoprostenol and 1,700 to 2,470 mi in patients who received danaparoid sodium during CPB (p < 0.05, Mann-Whitney U test), Conclusions. During CPB, inhibition of platelet aggregation by prostacyclin may be a safe anticoagulation approach in patients with type II HIT. (C) 2001 by The Society of Thoracic Surgeons.