Novel techniques in the use of bivalirudin for cardiopulmonary bypass anticoagulation in a child with heparin-induced thrombocytopenia

Perfusion ◽  
2011 ◽  
Vol 26 (6) ◽  
pp. 516-518 ◽  
Author(s):  
D Dragomer ◽  
A Chalfant ◽  
R Biniwale ◽  
B Reemtsen ◽  
M Federman
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Small Child ◽  
Heparin Induced Thrombocytopenia

Heparin-induced thrombocytopenia (HIT) occurs in both the pediatric and adult populations after exposure to heparin. Bivalirudin has been used as an alternative to heparin for adults undergoing cardiac surgery and cardiopulmonary bypass, but has only been used minimally in children for this purpose. We report the successful use of bivalirudin for anticoagulation during cardiopulmonary bypass in a small child with HIT, using novel techniques not previously described.

Successful use of bivalirudin for cardiopulmonary bypass in a patient with heparin allergy

Perfusion ◽  
2007 ◽  
Vol 22 (1) ◽  
pp. 67-69 ◽  
Author(s):  
F. Pappalardo ◽  
A. Franco ◽  
G. Crescenzi G ◽  
A. Poli ◽  
A. Zangrillo ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Half Life ◽  
Clinical Problem ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Allergy ◽  
Anaphylactoid Reactions ◽  
Ige Mediated

Heparin-induced IgE-mediated hypersensitivity and anaphylactoid reactions, although rare, can pose a serious clinical problem for patients requiring cardiopulmonary bypass (CPB). Bivalirudin is a bivalent reversible direct thrombin inhibitor, with a half-life of 25 min, eliminated mostly by proteolytic cleavage. There are some reports on the use of bivalirudin for cardiac surgery, particularly for heparin-induced thrombocytopenia (HIT), but none on cases of heparin allergy. We report a case of heparin allergy successfully managed for CPB with bivalirudin anticoagulation. Perfusion (2007) 22, 67-69.

scholarly journals Anticoagulation with Argatroban in a Patient with Heparin-Induced Thrombocytopenia and Renal Insufficiency Undergoing Orthotopic Heart Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Michael Stuart Green ◽  
Johann Mathew ◽  
Christopher Ryan Hoffman ◽  
Henry Liu
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Transplantation ◽  
Decompensated Heart Failure ◽  
Orthotopic Heart Transplantation ◽  
Clinical Use ◽  
Heparin Induced Thrombocytopenia ◽  
Advantages And Disadvantages ◽  
Immune Mediated

Unfractionated heparin is the anticoagulant of choice for cardiac surgery that requires cardiopulmonary bypass. However, it can cause serious side effects like heparin-induced thrombocytopenia (HIT), an immune-mediated process where antibodies are directed against heparin and platelet 4 complexes. In such cases, alternative pharmacologic strategies are implemented to facilitate safe bypass conditions. A woman with severe decompensated heart failure was heparinized for intra-aortic balloon pump and subsequent LVAD placement. On day 6, a fall in platelets from 113,000 to 26,000 was noted. She was diagnosed with HIT. Heparin was discontinued and replaced with an argatroban infusion for the duration of her care until heart transplantation was completed. We review the mechanism, diagnosis, and complications of HIT. We discuss cardiopulmonary bypass and its relation to heparin, HIT, and heparin alternatives. We discuss argatroban’s relevant pharmacology, clinical use, advantages, and disadvantages.

Patients with a History of Type II Heparin-Induced Thrombocytopenia with Thrombosis Requiring Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Observational Case Series

2003 ◽  
Vol 96 (2) ◽  
pp. 344-350 ◽  
Author(s):  
Gregory A. Nuttall ◽  
William C. Oliver ◽  
Paula J. Santrach ◽  
Robert D. McBane ◽  
Daniel B. Erpelding ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Case Series ◽  
Type Ii ◽  
Heparin Induced Thrombocytopenia ◽  
History Of

Cardiac surgery with cardiopulmonary bypass in patients with type II heparin-induced thrombocytopenia

2001 ◽  
Vol 71 (2) ◽  
pp. 678-683 ◽  
Author(s):  
Abdellah Aouifi ◽  
Pascale Blanc ◽  
Vincent Piriou ◽  
Olivier H Bastien ◽  
Patrick Ffrench ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Type Ii ◽  
Heparin Induced Thrombocytopenia

Management of refractory bleeding post-cardiopulmonary bypass in an acute heparin-induced thrombocytopenia type II renal failure patient who underwent urgent cardiac surgery with bivalirudin (Angiox®) anticoagulation

Perfusion ◽  
2017 ◽  
Vol 33 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Kimberly Hassen ◽  
Maria R. Maccaroni ◽  
Haytham Sabry ◽  
Smitangshu Mukherjee ◽  
Shankari Serumadar ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Factor Viia ◽  
Rescue Therapy ◽  
Management Approach ◽  
Anticoagulation Management ◽  
Heparin Induced Thrombocytopenia ◽  
Drug Of Choice ◽  
Randomized Controlled Studies

Acute heparin-induced thrombocytopenia (HIT) patients present a myriad of anticoagulation management challenges, in clinical settings where unfractionated heparin (UFH) is the traditional drug of choice. UFH use in cardiac surgery is a known entity that has been subject to rigorous research. Research has, thus, led to its unparalleled use and the development of well-established protocols for cardiac surgery. In comparison to UFH, bivalirudin use for acute HIT patients requiring urgent cardiac surgery with cardiopulmonary bypass (CPB) is still in its infancy. We describe the tailored post-CPB management of refractory bleeding in a 65-year-old infective endocarditis, acute HIT patient with renal failure who underwent urgent aortic valve replacement and mitral valve repair with bivalirudin anticoagulation. A management approach that entailed a combination of continuous venovenous haemofiltration (CVVH), 4-Factor prothrombin complex concentrate (PCC) (Beriplex), recombinant factor VIIa (rFactor VIIa) and desmopressin (DDAVP) were consecutively used post-operatively in theatre. Based on this case study experience, two modifications to institutional protocols are recommended. The first is the use of CVVH in theatre to eliminate bivalirudin in renal failure patients or in patients where bivalirudin elimination is prolonged. Secondly, a ‘rescue therapy/intervention’ algorithm for the swift identification of refractory bleeding post-CPB is also recommended. Rescue therapy agents, such as a 4-Factor PCCs and rFactor VIIa, should be incorporated into the protocol after a robust evidence-based search and agreement with the haematologist. The aim of these recommendations is to reduce the risk of bleeding associated with bivalirudin use for inexperienced institutions and experienced institutions alike, until larger randomized, controlled studies provide more in-depth knowledge to expand our clinical practice.

Patients with a History of Type II Heparin-Induced Thrombocytopenia with Thrombosis Requiring Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Observational Case Series

2003 ◽  
Vol 96 (2) ◽  
pp. 344-350 ◽  
Author(s):  
Gregory A. Nuttall ◽  
William C. Oliver ◽  
Paula J. Santrach ◽  
Robert D. McBane ◽  
Daniel B. Erpelding ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Case Series ◽  
Type Ii ◽  
Heparin Induced Thrombocytopenia ◽  
History Of

scholarly journals GTH 2021 State of the Art—Cardiac Surgery: The Perioperative Management of Heparin-Induced Thrombocytopenia in Cardiac Surgery

2021 ◽  
Vol 41 (01) ◽  
pp. 059-062
Author(s):  
Laura Ranta ◽  
Emmanuelle Scala
Keyword(s):  
Adverse Drug Reaction ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Multidisciplinary Approach ◽  
Perioperative Management ◽  
State Of The Art ◽  
Short Review ◽  
Prothrombotic State ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated

AbstractHeparin-induced thrombocytopenia (HIT) is a severe, immune-mediated, adverse drug reaction that paradoxically induces a prothrombotic state. Particularly in the setting of cardiac surgery, where full anticoagulation is required during cardiopulmonary bypass, the management of HIT can be highly challenging, and requires a multidisciplinary approach. In this short review, the different perioperative strategies to run cardiopulmonary bypass will be summarized.

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