Alternatives to unfractionated heparin for anticoagulation in cardiopulmonary bypass
Details
Serval ID
serval:BIB_1F48BEEC9AAD
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Alternatives to unfractionated heparin for anticoagulation in cardiopulmonary bypass
Journal
Perfusion
ISSN
0267-6591 (Print)
Publication state
Published
Issued date
09/2001
Volume
16
Number
5
Pages
411-6
Notes
Journal Article
Review --- Old month value: Sep
Review --- Old month value: Sep
Abstract
Despite the progress made in the development of cardiopulmonary bypass (CPB) equipment, systemic anticoagulation with unfractionated heparin and post-bypass neutralization with protamine are still used in most perfusion procedures. However, there are a number of situations where unfractionated 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 unfractionated heparin, including extreme hemodilution, low molecular weight heparins, danaparoid, ancrod, r-hirudin, abciximab, tirofiban, argatroban 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 unfractionated heparin and running CPB in a standard fashion despite HIT and thrombosis. Likewise, at the end of the procedure, unfractionated 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.
Keywords
Ancrod/therapeutic use
Antibodies, Monoclonal/therapeutic use
Anticoagulants/adverse effects/classification/*therapeutic use
*Cardiopulmonary Bypass/adverse effects
Chondroitin Sulfates/therapeutic use
Cross Reactions
Dermatan Sulfate/therapeutic use
Drug Combinations
Drug Hypersensitivity/etiology
Factor Xa/antagonists & inhibitors
Hemodilution
Hemorrhage/chemically induced
Heparin/adverse effects/*therapeutic use
Heparin, Low-Molecular-Weight/therapeutic use
Heparitin Sulfate/therapeutic use
Hirudin Therapy
Humans
Immunoglobulin Fab Fragments/therapeutic use
Perfusion
Pipecolic Acids/therapeutic use
Platelet Aggregation Inhibitors/therapeutic use
Protamines/adverse effects/therapeutic use
Thrombocytopenia/chemically induced
Thrombophilia/drug therapy/etiology
Thrombosis/prevention & control
Tyrosine/*analogs & derivatives/therapeutic use
Pubmed
Web of science
Create date
28/01/2008 9:31
Last modification date
20/08/2019 12:55