Cardiothoracic & vascular anesthesia
Efficacy of Therapeutic Plasma Exchange or Cangrelor as an Adjunctive Strategy to Facilitate Cardiopulmonary Bypass in Patients with Heparin-Induced Thrombocytopenia: A Systematic Review and Meta-Analysis
Authors' conclusion
TPE and cangrelor are feasible strategies to prevent thromboembolism in adults with HIT who require CPB with heparin.
Study context
- Population
- Adults having cardiac surgery with a history of heparin-induced thrombocytopenia (HIT), cardiopulmonary bypass (CPB) with heparin17 reports (therapeutic plasma exchange (TPE)), 6 reports (cangrelor)
- Participants
- 57 vs 15
- Comparison
- TPE or intravenous cangrelor as adjunct to CPB with heparin
- TPEn = 57
- Cangrelorn = 15
- Outcome
- Avoidance of thromboembolism (venous or arterial) during or after CPB
Methodological detailsproportional meta-analysis, random effects model, Search of MEDLINE, PubMed and Google Scholar
- Proportional meta-analysis
- Random effects model
- Search of MEDLINE, PubMed and Google Scholar
Pooled result
As reported in the abstract
Freedom from perioperative thromboembolism (weighted-pooled, proportional meta-analysis, random effects)
- TPE (57 patients, 17 reports): weighted-pooled freedom from perioperative thromboembolism
- 91.0% (95% CI 82.6%-96.9%)
- Cangrelor (15 patients, 6 reports): weighted-pooled freedom from perioperative thromboembolism
- 83.0% (95% CI 61.2%- 97.6%)
Original publication
Efficacy of Therapeutic Plasma Exchange or Cangrelor as an Adjunctive Strategy to Facilitate Cardiopulmonary Bypass in Patients with Heparin-Induced Thrombocytopenia: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. Published 12 September 2024. doi:10.
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