Aortocoronary vein bypass in a patient with type II heparin-associated thrombopenia: A case report

Abstract

Two types of heparin-associated thrombopenia (HAT) can be distinguished. Patients with type II HAT (HAT II) present a particularly difficult management problem when they require full anticoagulation. There is no consensus about the proper anticoagulation management for patients with HAT II who have to undergo cardiopulmonary bypass (CPB). We present a HAT II patient who underwent successful aortocoronary saphenous vein grafting. Sodium-danaparoid (SD) was used for anticoagulation. The anti-factor Xa level was kept below the values reported in the literature for patients undergoing CPB. We did not observe any fibrin formation during the time of CPB or any severe postoperative hemorrhage, which is frequently described in the literature. We discuss the management of our patient with SD intra- and postoperatively.