Document Detail

Bivalirudin use in carotid endarterectomy in a patient with heparin-induced thrombocytopenia.
MedLine Citation:
PMID:  16449539     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe the successful use of bivalirudin as the primary procedural anticoagulant in a patient with suspected heparin-induced thrombocytopenia (HIT) undergoing carotid endarterectomy (CEA). CASE SUMMARY: A 73-year-old white man presented for an elective CEA 3 weeks after emergent, on-pump coronary artery bypass grafting. Bivalirudin was used for procedural anticoagulation because of seropositivity for heparin-PF4 antibodies and a clinical history consistent with HIT. The dose was administered as a 0.75 mg/kg bolus and 1.75 mg/kg/h infusion as reported in percutaneous coronary intervention, based on review of the available bivalirudin literature. The dosage was adjusted for the patient's renal dysfunction. The outcome was successful, with the patient discharged home in 8 days without significant complications. DISCUSSION: During active HIT, when thrombocytopenia and heparin-PF4 antibodies are present, heparin therapy must be avoided. In patients with subacute HIT, when platelet counts have recovered but HIT antibodies are still present, it is also prudent to avoid heparin administration. In the case of a patient in whom anticoagulation is necessary but heparin use is contraindicated, a direct thrombin inhibitor, such as bivalirudin, may offer a viable alternative. Bivalirudin is not immunogenic and does not cross-react with the heparin-PF4 antibodies associated with HIT. To our knowledge, as of January 20, 2006, this is the first report of the use of bivalirudin for procedural anticoagulation during CEA in a patient with HIT antibodies and recent exposure to heparin. CONCLUSIONS: Further investigation is warranted to clarify the clinical benefits of bivalirudin for patients undergoing vascular surgery of the carotids, including potential advantages for vulnerable patient populations such as those with diagnosed or suspected HIT as well as those with renal dysfunction.
Shannon W Finks
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2006-01-31
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  40     ISSN:  1060-0280     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-07     Completed Date:  2006-03-31     Revised Date:  2006-10-13    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  340-3     Citation Subset:  IM    
Department of Pharmacy, University of Tennessee, Memphis, TN, USA.
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MeSH Terms
Antibodies / analysis
Anticoagulants / administration & dosage,  therapeutic use*
Endarterectomy, Carotid*
Heparin / adverse effects*,  immunology,  therapeutic use
Hirudins / administration & dosage
Peptide Fragments / administration & dosage,  therapeutic use*
Platelet Count
Recombinant Proteins / administration & dosage,  therapeutic use
Thrombocytopenia / blood,  chemically induced*,  immunology
Treatment Outcome
Reg. No./Substance:
0/Antibodies; 0/Anticoagulants; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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