Cangrelor As Treatment for Cardiac Surgery Associated With Heparin Induced Thrombocytopenia

Overview

Heparin-induced thrombocytopenia (HIT) is a rare but serious immune complication of heparin exposure that paradoxically increases the risk of thrombosis. In patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), heparin is essential to prevent circuit clotting, yet contraindicated in HIT. Available alternatives carry significant limitations. Cangrelor, an intravenous reversible P2Y12 inhibitor, has shown promise in case reports and small series in this context, but no multicenter study exists. CATCH-IT is a multicenter retrospective observational study conducted across 11 French cardiac surgery centers, aiming to describe the safety and efficacy of cangrelor combined with heparin during CPB in confirmed HIT patients, by estimating the incidence of major bleeding and thrombotic events within 7 days after surgery.

Heparin-induced thrombocytopenia (HIT) is an immunological complication characterized by thrombocytopenia and a paradoxical pro-thrombotic state due to anti-platelet factor 4 (anti-PF4) antibodies. In patients requiring cardiopulmonary bypass (CPB), anticoagulation management is particularly challenging: unfractionated heparin is essential to prevent circuit thrombosis, yet its use is contraindicated when anti-PF4 antibodies are present. Alternative anticoagulants (bivalirudin, argatroban, danaparoid) carry important limitations including slow kinetics, absence of a reversal agent, high bleeding risk, and elevated cost. Cangrelor, an intravenous reversible P2Y12 receptor inhibitor, offers rapid onset of action, full reversibility upon discontinuation, and no interaction with anti-PF4 antibodies. Its use during CPB in HIT patients has been reported in case reports and small series with favorable outcomes. However, no multicenter retrospective cohort study has yet characterized its real-world use, efficacy, or safety profile in this clinical context. Given the low incidence of HIT in cardiac surgery and the complexity of the perioperative setting, a prospective randomized trial is not feasible. A multicenter retrospective study is therefore the most appropriate methodology to achieve sufficient sample size and reliably describe practice patterns, cangrelor dosing modalities, and thromboembolic and hemorrhagic complication profiles. CATCH-IT will collect standardized data from existing medical records at 11 participating centers in France, covering patients operated between 2020 and 2025. No additional procedures or modifications to standard care are performed.