Cardiopulmonary bypass in patients with heparin-induced thrombocytopenia using Org 10172.
BACKGROUND
In patients with heparin-induced thrombocytopenia undergoing cardiac operations, anticoagulation with heparin should be avoided. The low-molecular-weight glycosaminoglycan Orgaran has been used as an alternative, but the overall experience is limited.


METHODS
Two patients with heparin-induced thrombocytopenia underwent cardiopulmonary bypass using Orgaran for anticoagulation. A 30-year-old woman suffered from emboli to her brain through a secondary atrial septal defect, a 14-year-old boy from ischemia of his left leg due to recurrent embolism originating from the mitral valve. In both cases, cardiopulmonary bypass was performed in a routine manner, except for using low-dose Orgaran instead of heparin. Anticoagulation was monitored during cardiopulmonary bypass by measuring Orgaran plasma levels and activated clotting time.


RESULTS
No thromboembolic or bleeding complications occurred during and after atrial septal defect repair and mitral valve replacement, respectively. In the former case, thrombotic material from the inferior vena cava was removed during hypothermic circulatory arrest within the same procedure. Activated clotting time did not correlate with plasma levels of Orgaran.


CONCLUSIONS
Orgaran might be a useful alternative for anticoagulation during extracorporeal circulation. Adequate dosages and measurement of plasma levels are recommended for its use in cardiopulmonary bypass.
Wilhelm
M J
MJ
Department of Thoracic and Cardiovascular Surgery, University of Münster, Germany.
Schmid
C
C
Kececioglu
D
D
Möllhoff
T
T
Ostermann
H
H
Scheld
H H
HH
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006349:Heart Valve Diseases / Q000601:surgery; D006493:Heparin / Q000009:adverse effects*; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008943:Mitral Valve; D013921:Thrombocytopenia / Q000139:chemically induced*; D013923:Thromboembolism / Q000601:surgery; D016896:Treatment Outcome
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid