CABG without using heparin in a patient with heparin-induced thrombocytopenia

BACKGROUND: Despite the low incidence of heparin-induced thrombocytopenia and thrombosis, these two syndromes are much disputed in life-threatening conditions especially in cardiovascular surgery where heparin is routinely used. Nowadays a pharmacological agent that can exactly replace heparin does not exist. Many of the drugs called "alternative drugs to heparin" are associated with a high risk of hemorrhagic complications and an increased need of blood transfusions. Neither the use of heparin nor "alternative drugs to heparin" may be the best way to revascularize a patient with heparin-induced thrombocytopenia. METHODS: Coronary artery bypass grafting without using heparin was performed in a 62-year-old male patient with heparin-induced thrombocytopenia. He received clopidogrel and acethyl salicylic acid for 2 days before operation. He was operated off-pump using special maneuvers. RESULTS: He was discharged on postoperative day 5 after an uneventful course and is doing well in the sixth month postoperatively. CONCLUSIONS: According to our investigations in English literature, this surgical technique and coronary artery bypass grafting without using heparin is firstly described in this article. Increasing the number of cases will show the reliability and safety of this method.