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Ann Thorac Surg 2003;76:638-648
© 2003 The Society of Thoracic Surgeons

Review

Heparin-induced thrombocytopenia and cardiac surgery

Theodore E. Warkentin, MDa*, Andreas Greinacher, MDb

a Departments of DEPARTMENT OF Pathology and Molecular Medicine, and DEPARTMENT OF Medicine, McMaster University, Hamilton, Ontario, Canada
b Department of Immunology and Transfusion Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany

* Address reprint requests to Dr Warkentin, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences (General Site), 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada.
e-mail: twarken{at}mcmaster.ca

Unfractionated heparin given during cardiopulmonary bypass is remarkably immunogenic, as 25% to 50% of postcardiac surgery patients develop heparin-dependent antibodies during the next 5 to 10 days. Sometimes, these antibodies strongly activate platelets and coagulation, thereby causing the prothrombotic disorder, heparin-induced thrombocytopenia. The risk of heparin-induced thrombocytopenia is 1% to 3% if unfractionated heparin is continued throughout the postoperative period. When cardiac surgery is urgently needed for a patient with acute or subacute heparin-induced thrombocytopenia, options include an alternative anticoagulant (bivalirudin, lepirudin, or danaparoid) or combining unfractionated heparin with a platelet antagonist (epoprostenol or tirofiban). As heparin-induced thrombocytopenia antibodies are transient, unfractionated heparin alone is appropriate in a patient with previous heparin-induced thrombocytopenia whose antibodies have disappeared.




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