Abstract
Heparin-Induced Thrombocytopenia type II (HIT type II) is a life-threatening complication of heparin therapy. It is inhibited to use heparin on patients with HIT type II, however the antibodies that mediate HIT type II (antibodies against heparin-platelet factor 4 (PF4) complex) are said to turn negative over several months, and after that, administering heparin may not cause a recurrence of HIT type II.
Therefore if a patient with a history of HIT type II that requires cardiopulmonary bypass surgery, it is recommended that we postpone the operation until its antibodies against PF4 complex disappear. After that, we can use heparin only for cardiopulmonary bypass, but we should use other kinds of anticoagulant such as antithrombin for others during operation. In this case, we can succeed in the management of a patient with a history of HIT type II requiring cardiac surgery with cardiopulmonary bypass according to this recommendation.
However, in such cases, patients always have a possibility to develope a recurrence of HIT type II. In this case we have to avoided administering heparin for the maximum extent. Furthermore, we need to consider what kind of anticoagulant we should use during perioperative period.
