| The emergency use of recombinant hirudin in cardiopulmonary bypass. | |
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MedLine Citation:
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PMID: 10915479 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The most common anticoagulant used for cardiopulmonary bypass is heparin. An alternate form of anticoagulant therapy is needed for patients who have immune-mediated heparin-associated thrombocytopenia (HIT). Thrombocytopenia causes bleeding and may lead to serious arterial and venous thrombosis. HIT or heparin-induced thrombocytopenia with thrombosis type II (HITT) are both described as adverse reactions to heparin. They are diagnosed with a platelet count less than a 100,000/mcl for 2 consecutive days. HITT, the severe form, is characterized with the thrombocytopenia in combination with thromboembolic complications, such as strokes, myocardial infarctions, and limb ischemia. Two cases are presented in which r-hirudin was used for anticoagulation for aortocoronary bypass surgery and mitral valve replacement. The activated partial prothrombin time (aPTT) was used to monitor coagulation. In the first case, the aPTT was maintained greater than 100 seconds, and at the termination of cardiopulmonary bypass, some clot was noted in the cardiopulmonary bypass circuit. In the second case, a longer cardiopulmonary bypass run was anticipated, the hirudin bolus and infusion rate were increased, and the aPTT was maintained at greater than 200 sec. Adequate coagulation resulted, and, at the end of bypass, no clot was noted. These case studies seem to suggest a higher dosage of r-hirudin may be required for the use of cardiopulmonary bypass and a need to maintain aPTT values greater than 200 sec to help monitor anticoagulation. |
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Authors:
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N Johnston; M E Jessen; M DiMaio; D S Douglass |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: The Journal of extra-corporeal technology Volume: 31 ISSN: 0022-1058 ISO Abbreviation: J Extra Corpor Technol Publication Date: 1999 Dec |
Date Detail:
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Created Date: 2000-06-09 Completed Date: 2000-06-09 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0267637 Medline TA: J Extra Corpor Technol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 211-5 Citation Subset: T |
Affiliation:
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Division of Thoracic and Cardiovascular Surgery, University of Texas Southwestern Medical Center at Dallas 75235-88679, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anticoagulants
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therapeutic use* Cardiopulmonary Bypass* / adverse effects Drug Administration Schedule Hirudin Therapy* Humans Male Middle Aged Recombinant Proteins / therapeutic use* Thrombocytopenia / blood, prevention & control* |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Recombinant Proteins |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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