Key result
Post-protamine bleeding due to persistent platelet blockade by tirofiban during cardiopulmonary bypass was successfully treated with one dose of rFVIIa (60 microg/kg) without thrombotic complications.
Why the study?
Does the use of unfractionated heparin and tirofiban for cardiopulmonary bypass, followed by rFVIIa for bleeding, safely manage anticoagulation in a patient with heparin-induced thrombocytopenia requiring redo cardiac surgery?
Case Report (n=1)
Does the use of unfractionated heparin and tirofiban for cardiopulmonary bypass, followed by rFVIIa for bleeding, safely manage anticoagulation in a patient with heparin-induced thrombocytopenia requiring redo cardiac surgery?
The combination of unfractionated heparin and tirofiban for cardiopulmonary bypass, with rFVIIa rescue for post-protamine bleeding, represents a viable anticoagulation strategy for patients with heparin-induced thrombocytopenia requiring cardiac surgery.
Single-dose rFVIIa may resolve tirofiban-related post-CPB bleeding without thrombosis; leaves open its role in HIT redo surgery.
Heparin-induced thrombocytopenia was diagnosed in a 50-year-old man on day 5 after cardiac surgery (aorto-coronary bypass and mitral valve replacement). He required redo (para-prosthesis leak) on day 13. The cardiopulmonary bypass (CPB) was performed with unfractionated heparin (UFH) and the platelet glycoprotein (GP) IIb/IIIa inhibitor tirofiban. Post-protamine bleeding likely due to documented persistent platelet blockade by tirofiban was successfully treated with one dose of recombinant activated factor VII (rFVIIa, 60 microg/kg). No thrombotic complications were detected. The management of CPB with UHF and tirofiban is a convenient option and rFVIIa seems appropriate to handle bleeding issues.
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Durand et al. (2008) conducted a case report in Heparin-induced thrombocytopenia and post-protamine bleeding (n=1). Unfractionated heparin, tirofiban, and rFVIIa was evaluated on Bleeding and thrombotic complications. Post-protamine bleeding due to persistent platelet blockade by tirofiban during cardiopulmonary bypass was successfully treated with one dose of rFVIIa (60 microg/kg) without thrombotic complications.
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