Question

What should be used for anticoagulation (AC) during cardiopulmonary bypass in a patient who has heparin-induced thrombocytopenia (HIT)?

1) Bivalirudin
2) Argatroban
3) Fondaparinux
4) Heparin

Answer 1

Bivalirudin or argatroban are typically used for anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia (HIT) because they do not cross-react with HIT antibodies.

Step-by-step explanation:

In patients who have heparin-induced thrombocytopenia (HIT), bivalirudin or argatroban are typically used for anticoagulation during cardiopulmonary bypass.

Bivalirudin is a direct thrombin inhibitor that binds to both circulating and clot-bound thrombin, preventing the conversion of fibrinogen to fibrin. Argatroban, on the other hand, is a direct thrombin inhibitor that selectively inhibits free and clot-bound thrombin.

Both bivalirudin and argatroban are alternatives to heparin for patients with HIT because they do not cross-react with HIT antibodies.