Alternatives to unfractioned heparin for anticoagulation in cardiopulmonary bypass

von Segesser, L.K.; Mueller, X.; Marty, B.; Horisberger, J.; Corno, A.
September 2001
Perfusion;Sep2001, Vol. 16 Issue 5, p411
Academic Journal
Despite the progress made in the development of cardiopulmonary bypass (CPB) equipment, systemic anticoagulation with unfractioned heparin and post-bypass neutralization with protamine are still used in most perfusion procedures. However, there are a number of situations where unfractioned heparin, protamine or both cannot be used for various reasons. Intolerance of protamine can be addressed with extracorporeal heparin removal devices, perfusion with (no) low systemic heparinization and, to some degree, by perfusion with alternative anticoagulants. Various alternative anticoagulation regimens have been used in cases of intolerance to unfractioned heparin, including extreme hemodilution, low molecular weight heparins, danaparoid, ancrod, r-hirudin, abciximab, tirofiban, argatoban and others. In the presence of heparin-induced thrombocytopenia (HIT) and thrombosis, the use of r-hirudin appears to be an acceptable solution which has been well studied. The main issue with r-hirudin is the difficulty in monitoring its activity during CPB, despite the fact that ecarin coagulation time assessment is now available. A more recent approach is based on selective blockage of platelet aggregation by means of monoclonal antibodies directed to GPIIb/IIIa receptors (abciximab) or the use of a GPIIb/IIIa inhibitor (tirofiban). An 80% blockage of the GPIIb/IIIa receptors and suppression of platelet aggregation to less than 20% allows the giving of unfractioned heparin and running CPB in a standard fashion despite HIT and thrombosis. Likewise, at the end of the procedure, unfractioned heparin is neutralized with protamine as usual and donor platelets are transfused if necessary. GPIIb/IIIa inhibitors are frequently used in interventional cardiology and, therefore, are available in most hospitals.


Related Articles

  • Optimal Anticoagulation in Cardiovascular Surgery. Pifarré, Roque // Clinical & Applied Thrombosis/Hemostasis;Summer1995, Vol. 1 Issue 3, p173 

    Despite current developments in anticoagulant drugs, unfractionated heparin has remained the drug of choice for anticoagulation during cardiopulmonary by-pass surgical procedures. The use of heparin has been associated with problems. Heparin-induced thrombocytopenia, intra- and postoperative...

  • Protamine Reversal of Heparin After Cardiopulmonary Bypass Increases Lung Resistance, Not Elastance. Gilbert, Timothy B.; Barnas, George M.; Miller, David W.; Sequeira, Alejandro J. // Journal of Cardiovascular Pharmacology & Therapeutics;Sep1999, Vol. 4 Issue 3, p137 

    The article presents a study on increasing lung resistance through protamine reversal of heparin after cardiopulmonary bypass (CPB). It is observed that the changes in lung resistance after CPB were greatest in those patients who received the most nearly balanced doses of heparin and protamine....

  • Use of danaparoid sodium (Orgaran[sup ®] ) as an alternative to heparin sodium during cardiopulmonary bypass: a clinical evaluation of six cases. Fernandes, Philip; Mayer, Richard; MacDonald, James L.; Cleland, Andrew G.; Hay-McKay, Christine // Perfusion;Oct2000, Vol. 15 Issue 6, p531 

    Heparin-induced thrombocytopenia (HIT) has become more prevalent in today's cardiac setting and has resulted in the need for alternative anticoagulant therapies. Danaparoid sodium, one alternative to heparin, has been used in six cardiopulmonary bypass procedures in this hospital. This clinical...

  • Delayed thrombin generation is not associated with fibrinopeptide formation during prolonged cardiopulmonary bypass with hirudin anticoagulation. Belway, D.; Rubens, F. D.; Henley, B.; Babaev, A.; Mesana, T. // Perfusion;Sep2006, Vol. 21 Issue 5, p259 

    Patients with heparin-induced thrombocytopenia urgently requiring surgery with cardiopulmonary bypass (CPB) present a unique management challenge that must be addressed by the use of alternative anticoagulants. Although clinical success with the direct thrombin inhibitor hirudin has been...

  • A Comparison of Heparin and New Anticoagulants for Cardiopulmonary Bypass Surgery. Belougne-Malfattie, Emmanuelle; Aguejouf, Omar; Labrousse, Louis; Doutremepuich, Christian // Clinical & Applied Thrombosis/Hemostasis;Apr1998, Vol. 4 Issue 2, p118 

    Heparin is still the major anticoagulant of choice during CPB. but it may cause thrombocytopenia and severe bleeding in patients. In light of these complications, the development of new anticoagulant drugs seemed to be necessary for these patients. Many experimental studies focused on r-hirudin,...

  • Coagulation disorders of cardiopulmonary bypass: a review. Paparella, Domenico; Brister, Stephanie J.; Buchanan, Michael R. // Intensive Care Medicine;Oct2004, Vol. 30 Issue 10, p1873 

    Background: Postoperative bleeding is one of the most common complications of cardiac surgery.Discussion: Extensive surgical trauma, prolonged blood contact with the artificial surface of the cardiopulmonary bypass (CPB) circuit, high doses of heparin, and hypothermia...

  • Thrombocytopenia Associated with Antithrombotic Therapy in Patients with Cardiovascular Diseases: Diagnosis and Treatment. Kilickiran Avci, Burcak; Oto, Ali; Ozcebe, Osman // American Journal of Cardiovascular Drugs;2008, Vol. 8 Issue 5, p327 

    Agents with antiplatelet and anticoagulant activity have been proved to be effective in reducing the incidence of complications following acute coronary syndrome, percutaneous coronary intervention, and cardiopulmonary bypass. However, these agents, including heparin, glycoprotein IIb/IIIa...

  • Non-recovery of ACT in a patient with heparin-induced thrombocytopenia type II during mitral valve replacement using argatroban anticoagulation. Tanigawa, Yoshinori; Yamada, Tomoko; Matsumoto, Koichi; Nakagawachi, Akira; Torikai, Arisu; Sakaguchi, Yoshirou // Journal of Anesthesia;Dec2013, Vol. 27 Issue 6, p951 

    Argatroban was used as the anticoagulant during cardiopulmonary bypass (CPB) in a patient with heparin-induced thrombocytopenia (HIT) type II undergoing mitral valve replacement. Dosage was reduced because of preoperative congestive liver disorder. Perioperative coagulability was poor, and,...

  • Challenges encountered with argatroban anticoagulation during cardiopulmonary bypass. Agarwal, Shvetank; Ullom, Beth; Al-Baghdadi, Yasser; Okumura, Michael // Journal of Anaesthesiology Clinical Pharmacology;Jan2012, Vol. 28 Issue 1, p106 

    Use of argatroban as an alternative to heparin during cardiopulmonary bypass (CPB) in patients with heparin-induced thrombocytopenia has gained some attention in the past two decades. Dosing of argatroban during CPB is complex due to lack of complete understanding of its pharmacokinetic profile...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics