ArticleThe Annals of thoracic surgery2021
Safety of Intravenous Heparin for Cardiac Surgery in Patients With Alpha-Gal Syndrome.
Article in The Annals of thoracic surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed, 41 citations in OpenAlex.
- Perioperative Considerations for Alpha-Gal Syndrome: A Literature Review and Single-Center Experience in a Highly Endemic Area.Diseases (Basel, Switzerland) · 2026Review
- Review
- Alpha-gal xenoantigens in bioprosthetic valve recipients: clinical implications for bioprosthesis longevity.Journal of cardiothoracic surgery · 2026Review
- Heparin-Induced Anaphylaxis With Cardiac Arrest in a Patient With Alpha-Gal Syndrome: A Case Report.Cureus · 2026Article
- Alpha-gal sensitization and allergic blood transfusion reactions: a scoping review.Journal of translational medicine · 2026Article
- Intraoperative Anaphylaxis in the Setting of Undiagnosed Alpha-Gal Syndrome: A Heart Team Clinical Conundrum.JACC. Case reports · 2026Article
- Managing Alpha-Gal Allergy in a Case of Bioprosthetic TAVR.Case reports in immunology · 2026Article
- Perioperative Outcomes After Bioprosthetic Valve Replacement in Patients Sensitized to Alpha-Gal.Annals of thoracic surgery short reports · 2025Article
- Alpha-Gal Syndrome: Often Hidden, Under-Recognized, and in Need of Attention-A Rapid Review.International journal of general medicine · 2025Review
- Neurosurgical Management of Patients with Alpha-Gal Syndrome.Journal of neurological surgery reports · 2024Article
- Review
- Alpha gal syndrome, a relative not absolute contraindication to the use of bovine pericardium to close an intracardiac septal defect: a case report.Journal of cardiothoracic surgery · 2024Article
- Article
- Review
- The α-Gal epitope - the cause of a global allergic disease.Frontiers in immunology · 2024Review
- Importance of alpha-gal syndrome in patients undergoing catheter ablation.HeartRhythm case reports · 2023Article
- Perioperative implications of patients with alpha gal allergies.Journal of clinical anesthesia · 2023Review
- Anaphylaxis to Excipients in Current Clinical Practice: Evaluation and Management.Immunology and allergy clinics of North America · 2022Review
- [Alpha-gal syndrome : Overview of clinical presentation and pathophysiology].Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete · 2022Review
- The Meat of the Matter: Understanding and Managing Alpha-Gal Syndrome.ImmunoTargets and therapy · 2022Review
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
backgroundAlpha-gal syndrome is a tick-acquired disease caused by immunoglobulin E (IgE) to the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal), causing allergic reactions to meat and products sourced from nonprimate mammals. As heparin is porcine-derived, we hypothesized that patients with alpha-gal syndrome who received high-dose heparin for cardiac surgery would have increased risk of anaphylaxis.
methodsAll cardiac surgery patients at an academic medical center from 2007 to 2019 were cross-referenced with research and clinical databases for the alpha-gal IgE blood test. Clinical data were obtained through the institutional Society of Thoracic Surgeons Adult Cardiac Database and chart review. Patients were stratified by development of an allergic reaction for univariate statistical analysis.
resultsOf the 8819 patients, 17 (0.19%) had a positive alpha-gal test before cardiac surgery. Of these 17 patients, 4 (24%) had a severe allergic reaction. The median alpha-gal titer was significantly higher in patients with a reaction (75 [interquartile range, 61-96] IU/mL vs 8 [interquartile range, 3-18] IU/mL; P = .006). There were no differences in median heparin loading dose, total dose, or maximum activated clotting time (all P > .05). In a subgroup of 8 patients with recent alpha-gal IgE level, 4 (50%) developed an allergic reaction.
conclusionsAlthough alpha-gal is rare in patients undergoing cardiac surgery, there is up to a 50% risk of serious allergic reaction to heparin for cardiopulmonary bypass. Higher preoperative alpha-gal titers may confer a higher risk of severe allergic reaction. For patients with a clinical suspicion of alpha-gal syndrome, we recommend prescreening with IgE levels and premedicating before receiving high doses of intravenous heparin.
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