Heparinoid anticoagulation and topical fibrin sealant in heparin-induced thrombocytopenia.
The development of heparin-induced thrombocytopenia in patients who require systemic anticoagulation for cardiac and vascular operations poses a therapeutic dilemma because no alternative anticoagulants are generally available. Heparinoid (Org 10172) has been used as an alternative anticoagulant under protocol or on a compassionate use basis, and has recently been approved by the Food and Drug Administration. There is, however, no heparinoid antagonist to reverse the anticoagulation. This report describes the combined use of heparinoid anticoagulation and adjunctive fibrin sealant for topical hemostasis in a patient with heparin-induced thrombocytopenia. Recommendations for perioperative monitoring of heparinoid anticoagulation are provided.
Jackson
M R
MR
Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
Danby
C A
CA
Alving
B M
BM
D000925:Anticoagulants / Q000627:therapeutic use*; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects*; D006496:Heparinoids / Q000627:therapeutic use*; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced*
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D015718:Fibrin Tissue Adhesive; D006493:Heparin; D006496:Heparinoids; D006497:Heparan Sulfate; C035838:danaparoid