Poster Presentation: Alternative Methods of Anticoagulation in a Patient with A History of Heparin-Induced Thrombocytopenia-Alternative Methods of Anticoagulation in a Patient with A History of Heparin-Induced Thrombocytopenia

Alternative Methods of Anticoagulation in a Patient with A History of Heparin-Induced Thrombocytopenia

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This document details a comprehensive study regarding the use of heparin in patients with a history of heparin-induced thrombocytopenia (HIT) during vascular surgery, with specific reference to a case study involving a 60-year-old female patient. <br /><br />### Methods<br />Databases such as PubMed and Embase were systematically searched using specific keywords related to HIT and vascular surgery. The search identified relevant articles, including a retrospective review, clinical practice guidelines, and several case studies, without any result limitations.<br /><br />### Introduction<br />Heparin is commonly used as an anticoagulant in cardiovascular procedures, but HIT is a rare yet serious complication that occurs in a small percentage of the population. HIT involves the formation of antibodies against the heparin-platelet factor 4 (PF4/H) complex, leading to thrombocytopenia and thrombosis. These antibodies circulate for an average of 85 days post-heparin exposure. The American Society of Hematology (ASH) generally advises against the use of heparin in patients with a history of HIT, except under special circumstances.<br /><br />### Case Study<br />A 60-year-old female with multiple comorbidities and a history of HIT diagnosed over a year ago underwent a carotid endarterectomy (CEA). Due to her HIT history, she was administered argatroban, a direct thrombin inhibitor, instead of heparin. The procedure and postoperative period were uncomplicated, and she was successfully discharged without neurological deficits.<br /><br />### Recommendations and Conclusions<br />- Heparin may be used intraoperatively in patients with remote HIT who are free of anti-PF4/H antibodies.<br />- Alternative anticoagulants, such as argatroban, should be used pre- and postoperatively to avoid reformation of antibodies due to prolonged heparin exposure.<br />- Limited research necessitates further studies, including systematic reviews and randomized controlled trials, to solidify the safety guidelines of heparin use in patients with a history of HIT.<br /><br />### Discussion<br />The successful use of argatroban in this case illustrates its potential as a viable alternative for anticoagulation in similar patients. Future practice could consider heparin use in remote HIT status patients after confirming the absence of active antibodies, enhancing patient management and outcomes.

Keywords

heparin

heparin-induced thrombocytopenia

HIT

vascular surgery

anticoagulants

argatroban

case study

cardiovascular procedures

thrombocytopenia

antibodies