Document Detail


Successful use of Argatroban as a heparin substitute during cardiopulmonary bypass: heparin-induced thrombocytopenia in a high-risk cardiac surgical patient.
MedLine Citation:
PMID:  12735590     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Whereas heparin is the most widely used intravenous anticoagulant in the US for the treatment of thromboembolic disease and is a seminal adjunct to many clinical procedures, its use can cause serious adverse events. Heparin-induced thrombocytopenia (HIT) has emerged as one of the most frequently seen complications of heparin therapy and can be a life-threatening immunohematological challenge for patients requiring cardiopulmonary bypass (CPB) with obligatory heparin exposure. Unfortunately, lack of convenient monitoring techniques and the presence of HIT and other comorbidities in the complex patient frequently limits or precludes the use of most alternatives to heparin anticoagulation during CPB. This case report describes the successful use of the celite activated clotting time and high-dose thrombin time, while using the direct thrombin inhibitor Argatroban as an alternative to heparin anticoagulation during CPB in a high-risk patient presenting with type II HIT, end-stage renal failure, and ischemic cardiomyopathy with ventricular fibrillatory arrest.
Authors:
Jeff T Edwards; James K Hamby; Neil K Worrall
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  75     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-08     Completed Date:  2003-05-22     Revised Date:  2004-12-08    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1622-4     Citation Subset:  AIM; IM    
Affiliation:
The Heart Institute of Spokane, Spokane, Washington 99204, USA. jte11@mindspring.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / adverse effects*
Antithrombins / therapeutic use*
Cardiopulmonary Bypass*
Female
Heparin / adverse effects*
Humans
Pipecolic Acids / therapeutic use*
Risk Factors
Thrombin Time
Thrombocytopenia / chemically induced*
Whole Blood Coagulation Time
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Antithrombins; 0/Pipecolic Acids; 74863-84-6/argatroban; 9005-49-6/Heparin

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


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