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Blood, 15 November 2008, Vol. 112, No. 10, pp. 4024-4027. Prepublished online as a Blood First Edition Paper on September 12, 2008; DOI 10.1182/blood-2008-03-145243. This Article Full Text (PDF) All Versions of this Article: blood-2008-03-145243v1 112/10/4024    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Selleng, S. Articles by Greinacher, A. Search for Related Content PubMed PubMed Citation Articles by Selleng, S. Articles by Greinacher, A. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted March 19, 2008 Accepted August 10, 2008 Management of anticoagulation in patients with subacute heparin-induced thrombocytopenia scheduled for heart transplantation Sixten Selleng, Assad Haneya, Stephan Hirt, Kathleen Selleng, Christof Schmid, and Andreas Greinacher* Institut fur Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universitat Greifswald, Greifswald, Germany Klinik fur Herz-, Thorax- und herznahe Gefaßchirurgie, Klinikum der Universitat Regensburg, Regensburg, Germany * Corresponding author; email: greinach{at}uni-greifswald.de. Anticoagulation management of patients with recent heparin-induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB) surgery is a serious challenge, and especially difficult in patients requiring urgent heart transplantation. As non-heparin anticoagulants during CPB bear a high risk of major bleeding, these patients are at risk to be taken off the transplant list. Short-term use of unfractionated heparin (UFH) for CPB, with restriction of UFH to the surgery itself, is safe and effective in patients with a history of HIT who test negative for anti-platelet factor 4 (PF4)/heparin antibodies. We present evidence that it is safe to expand the concept of UFH-re-exposure to patients with subacute HIT, i.e. patients with recent HIT in whom the platelet count has recovered but in whom anti-PF4/heparin IgG antibodies remain detectable, requiring heart transplantation, if they test negative by a sensitive functional assay using washed platelets. This can be live-saving in patients with end-stage heart failure. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: T. E. Warkentin, A. Greinacher, and A. Koster Heparin-induced thrombocytopenia in patients with ventricular assist devices: are new prevention strategies required? Ann. Thorac. Surg., May 1, 2009; 87(5): 1633 - 1640. [Abstract] [Full Text] [PDF]

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