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Ann Thorac Surg 2003;76:2121-2131
© 2003 The Society of Thoracic Surgeons
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
| The version of the article by Drs Warkentin and Greinacher, originally published in the August 2003 issue of The Annals of Thoracic Surgery (76:638–48) was inadvertently printed without the corrections the authors made in proof. The correct article appears here. The Annals regrets the error that occurred.
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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 beyond the first postoperative week. 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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