CCP Anticoagulation & Heparin Management 3

Question 1

A patient develops heparin-induced thrombocytopenia type II (HIT II) prior to elective CABG. Which anticoagulant is most appropriate for CPB?

Accepted Answer

Bivalirudin

Answer

Bivalirudin is the preferred alternative anticoagulant for CPB in HIT II patients because it directly inhibits thrombin without cross-reactivity to heparin-PF4 antibodies.

Question 2

What is the primary disadvantage of using bivalirudin as an anticoagulant during CPB compared to unfractionated heparin?

Accepted Answer

No reversal agent is available

Answer

Unlike heparin, which can be reversed by protamine, there is no specific reversal agent for bivalirudin, which poses challenges if rapid anticoagulation reversal is needed.

Question 3

Which laboratory test is used to diagnose heparin-induced thrombocytopenia type II (HIT II)?

Accepted Answer

Heparin-PF4 antibody assay (ELISA) and serotonin release assay (SRA)

Answer

HIT II diagnosis combines an immunological test (ELISA for heparin-PF4 antibodies) and a functional assay (SRA) to confirm platelet-activating antibodies.

Question 4

After CPB, a patient receives 350 mg of protamine to neutralize heparin. The ACT remains elevated at 180 seconds (baseline 120 s). What is the most appropriate next step?

Accepted Answer

Administer additional protamine

Answer

A persistently elevated post-protamine ACT suggests inadequate heparin reversal, and additional small doses of protamine (25–50 mg) should be administered.

Question 5

Which of the following best describes 'heparin rebound' after cardiac surgery?

Accepted Answer

Re-elevation of ACT hours after protamine reversal due to heparin re-entering circulation from tissue depots

Answer

Heparin rebound occurs when heparin sequestered in tissue depots re-enters the systemic circulation hours after protamine reversal, causing re-anticoagulation.

(CCP) Certified Clinical Perfusionist Practice Test

(CCP) Certified Clinical Perfusionist Practice Test

CCP Anticoagulation & Heparin Management 3