ArticleHematology. American Society of Hematology. Education Program2021
Heparin-induced thrombocytopenia and cardiovascular surgery.
Article in Hematology. American Society of Hematology. Education Program, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Heparin-induced thrombocytopenia in patients with mechanical circulatory support: a systematic review and meta-analysis.Research and practice in thrombosis and haemostasis · 2026Pooled it
- Profound Thrombocytopenia and Dyspnea 11 Days After Cardiac Surgery.American journal of hematology · 2025Article
- Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks : Coagulation Management in Cardiac Surgery.Galen medical journal · 2025Review
- Reducing perioperative red blood cell transfusion in adult aortic surgery: innovative application and process optimization of autologous plateletpheresis.Anesthesiology and perioperative science · 2025Article
- Practical guide to the diagnosis and management of heparin-induced thrombocytopenia.Hematology. American Society of Hematology. Education Program · 2024Review
- Approaches to management of HIT in complex scenarios, including cardiac surgery.Hematology. American Society of Hematology. Education Program · 2024Review
- Bolus-only bivalirudin for carotid endarterectomy in a patient with heparin-induced thrombocytopenia.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024Article
- Challenges in the Monitoring of Therapeutic Plasma Exchange during Acute Heparin-Induced Thrombocytopenia in Adults under ECMO.TH open : companion journal to thrombosis and haemostasis · 2024Article
- Cangrelor for cardiopulmonary bypass in delayed-onset heparin-induced thrombocytopenia: a case report.Research and practice in thrombosis and haemostasis · 2023Article
- Heparin-induced thrombocytopenia: An illustrated review.Research and practice in thrombosis and haemostasis · 2023Article
- Temporal presentations of heparin-induced thrombocytopenia following cardiac surgery: A single-center, retrospective cohort study.Journal of thrombosis and haemostasis : JTH · 2022Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Clinicians generally counsel patients with a history of heparin-induced thrombocytopenia (HIT) to avoid heparin products lifelong. Although there are now many alternative (nonheparin) anticoagulants available, heparin avoidance remains challenging for cardiac surgery. Heparin is often preferred in the cardiac surgery setting based on the vast experience with the agent, ease of monitoring, and reversibility. To "clear" a patient with a history of HIT for cardiac surgery, hematologists must first confirm the diagnosis of HIT, which can be challenging due to the ubiquity of heparin exposure and frequency of thrombocytopenia in patients in the cardiac intensive care unit. Next, the "phase of HIT" (acute HIT, subacute HIT A/B, or remote HIT) should be established based on platelet count, immunoassay for antibodies to platelet factor 4/heparin complexes, and a functional assay (eg, serotonin release assay). As long as the HIT functional assay remains positive (acute HIT or subacute HIT A), cardiac surgery should be delayed if possible. If surgery cannot be delayed, an alternative anticoagulant (preferably bivalirudin) may be used. Alternatively, heparin may be used with either preoperative/intraoperative plasma exchange or together with a potent antiplatelet agent. The optimal strategy among these options is not known, and the choice depends on institutional experience and availability of alternative anticoagulants. In the later phases of HIT (subacute HIT B or remote HIT), brief intraoperative exposure to heparin followed by an alternative anticoagulant as needed in the postoperative setting is recommended.
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Registered trials
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