Based on the current available data, we believe that the strategy of UFH plus antiplatelet therapy, particularly during CPB is easy to perform and is associated with a minimal risk of bleeding complications, even in extended, complex surgeries. Tirofiban might be preferred in hemodynamically unstable or hypoten-sive patients, whereas prostaglandins might be advisable for procedures that also require profound reduction of the pulmonary artery pressure, such as in heart transplantation or implantation of a left ventricular assist device. However, as HIT might be only attenuated, with the theoretical potential for a prothrombotic state during recovery of platelet function, these strategies are not be the first choice in a patient with acute HIT.

Concerning OPCAB surgery and vascular surgery, it should be noted that it is difficult to establish hemofiltration for augmented elimination of tirofiban intraoperatively.

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