Objective: To determine whether fondaparinux is effective in the treatment of thrombosis due to heparin-induced thrombocytopenia (HIT) in cardiac surgery we reported three cases successfully treated with fondaparinux and withdrawal of all heparins. Patients: All three patients were female and underwent heart valve replacement using cardiopulmonary bypass. Combined clinical criteria, "4T score" (Thrombocytopenia, Timing, Thrombosis, and absence of oTher explanations) and laboratory testing have

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... een used for diagnosis. In all patients the point of heparin immunization occurred in the preoperative period, during the angiography when a standard dose of UFH (5,000 IU) was administered. Then, during cardiac surgery, patients received a high dose of UFH, and later LMWH was used. Thrombocytopenia occurring between postoperative days 5 and 10 was associated with severe venous end/or arterial thrombosis. Other causes of thrombocytopenia were excluded. Thus, there was a high clinical suspicion (4T's=7 points) of HIT, and while awaiting the results of laboratory tests all sources of heparin were removed and fondaparinux was administered at therapeutical doses. Clinical and cardio-pulmonary thrombosis imaging resolution and platelet recovery were achieved in all cases with no new thrombotic or haemorrhagic event. Conclusions: Despite significant limitations exist regarding this retrospective evaluation, our data further support the observational evidence that fondaparinux is a safe and effective option in HIT-related thromboembolic complications with a good anticoagulant action and low risk of bleeding events.