Management of anticoagulation in patients with heparin-induced thrombocytopenia requiring cardiac surgery with cardiopulmonary bypass: guidance from the ISTH SSC on Perioperative and Critical Care Haemostasis and Thrombosis.
J Thromb HaemostJun 4, 2026 (epub)
Allyson M Pishko, Corinne Frere, Cheryl L Maier et al.
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In 30 seconds
This systematic review evaluated anticoagulation strategies for patients with heparin-induced thrombocytopenia (HIT) undergoing cardiac surgery with cardiopulmonary bypass. Among 30 studies reviewed, bivalirudin was identified as the most supported option, though it is associated with increased bleeding risks. The findings emphasize the need for tailored anticoagulation approaches in this high-risk population.
Key findings
- Bivalirudin has the strongest supporting data for anticoagulation in HIT patients during cardiac surgery.
- Therapeutic plasma exchange (TPE) can reduce antibody titers, facilitating the use of unfractionated heparin (UFH).
- Limited intraoperative UFH reexposure in patients with negative functional assays shows a low risk of HIT recurrence.
Why it matters
Understanding effective anticoagulation strategies in patients with HIT is crucial for minimizing thrombotic and bleeding risks during cardiac surgery. This guidance aids clinicians in making informed decisions in complex perioperative scenarios.