Treatment of Heparin-Induced Thrombocytopenia in the Setting of Venoarterial Extracorporeal Membrane Oxygenation as a Bridge to Orthotopic Heart Transplant.

Abstract

Heparin-induced thrombocytopenia (HIT) is a highly impactful prothrombotic condition produced by antibody formation after heparin administration, which leads to platelet activation and both thrombocytopenia and paradoxical thrombosis. HIT has a relatively high mortality rate and greatly complicates anticoagulation strategy in patients requiring surgeries necessitating cardiopulmonary bypass, such as orthotopic heart transplant (OHT). Here, we present a small case report involving two patients who developed HIT in the setting of ongoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for cardiogenic shock while being listed for OHT and the novel plasma exchange strategy that was utilized to manage their HIT through the transplant process.