Cangrelor for cardiopulmonary bypass in delayed-onset heparin-induced thrombocytopenia: a case report

• Published in: Research and practice in thrombosis and haemostasis 2023-10, Vol.7 (7), p.102230, Article 102230
• Main Authors: Durost, Maxime B., Marlu, Raphaël, Piliero, Nicolas, Sebestyen, Alexandre, Bedague, Damien
• Format: Article
• Language: English
• Subjects: cangrelor; cardiopulmonary bypass; heparin; thrombocytopenia; thrombosis
• ISSN: 2475-0379; 2475-0379
• DOI: 10.1016/j.rpth.2023.102230

Anticoagulation for cardiopulmonary bypass (CPB) in cases of heparin-induced thrombocytopenia (HIT) is challenging as no convenient and proven alternative, such as heparin alone, exists. A “platelet anesthesia” concept using antiplatelet agent cangrelor with heparin has been successfully reported in this setting. In cases of acute HIT, is CPB with cangrelor plus heparin effective and safe?. We report the case of a patient who developed, 2 weeks after patent foramen ovale (PFO) closure, a delayed-onset HIT complicated with carotid, popliteal, and PFO device thromboses that could not be controlled by argatroban anticoagulation and required urgent cardiac surgery. CPB for PFO occluder removal and popliteal thrombectomy were performed using cangrelor with heparin without complication. Neither a new thromboembolic event nor abnormal bleeding was noticed in the postoperative period. CPB using cangrelor with heparin seems to be an effective alternative for acute HIT. •Cardiopulmonary bypass (CPB) is a challenging issue in cases of acute heparin-induced thrombocytopenia (HIT).•No preferred anticoagulation strategy for acute HIT requiring CPB is well-established.•Cangrelor is a powerful antiplatelet agent with suitable properties for CPB.•Cangrelor with heparin is a possible anticoagulation regimen for CPB in cases of acute HIT.