Thrombosis due to Heparin-Induced Thrombocytopenia in Cardiac Surgery: is Fondaparinux an Effective Treatment?
|David Barilla1*, Gian Luca Martinelli2, Attilio Cotroneo2, Angelo Romano3 and Pasquale Iacopino4|
|1Vascular Surgery Department, Ospedali Riuniti "Bianchi Melacrino Morelli", Reggio, Calabria, Italy|
|2Cardiac Surgery Department, Clinica San Gaudenzio gruppo Policlinico di Monza, Novara, Italy|
|3CardioVascular Anesthesiology Department, Clinica San Gaudenzio gruppo Policlinico di Monza, Novara, Italy|
|4Haematology Unit, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bari, Italy|
|*Corresponding Author :||David Barilla
Vascular Surgery Department
Ospedali Riuniti "Bianchi Melacrino Morelli"
Reggio, Calabria, Italy
E-mail: [email protected]
|Received: March 10, 2016 Accepted: March 29, 2016 Published: March 31, 2016|
|Citation: Barilla D, Martinelli GL, Cotroneo A, Romano A, Iacopino P (2016) Thrombosis due to Heparin-induced Thrombocytopenia in Cardiac Surgery: is Fondaparinux an Effective Treatment?. J Cardiovasc Dis Diagn 4:240. doi:10.4172/2329-9517.1000240|
|Copyright: © 2016 Barilla D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Objective: To determine whether fondaparinux is effective in the treatment of thrombosis due to heparin-induced thrombocytopenia (HIT) in cardiac surgery we reported three cases successfully treated with fondaparinux and withdrawal of all heparins.
Patients: All three patients were female and underwent heart valve replacement using cardiopulmonary bypass. Combined clinical criteria, "4T score" (Thrombocytopenia, Timing, Thrombosis, and absence of oTher explanations) and laboratory testing have been used for diagnosis. In all patients the point of heparin immunization occurred in the preoperative period, during the angiography when a standard dose of UFH (5,000 IU) was administered. Then, during cardiac surgery, patients received a high dose of UFH, and later LMWH was used. Thrombocytopenia occurring between postoperative days 5 and 10 was associated with severe venous end/or arterial thrombosis. Other causes of thrombocytopenia were excluded. Thus, there was a high clinical suspicion (4T's=7 points) of HIT, and while awaiting the results of laboratory tests all sources of heparin were removed and fondaparinux was administered at therapeutical doses. Clinical and cardio-pulmonary thrombosis imaging resolution and platelet recovery were achieved in all cases with no new thrombotic or haemorrhagic event.
Conclusions: Despite significant limitations exist regarding this retrospective evaluation, our data further support the observational evidence that fondaparinux is a safe and effective option in HITâÂÂrelated thromboembolic complications with a good anticoagulant action and low risk of bleeding events.