[Heparin-induced thrombocytopenia type II. Intra- and postoperative lepirudin treatment in acute ischemia of the extremities].
METHODS
A 60-year-old woman was admitted because of acute ischemia of the right leg. The patient had been immobilized during diagnostic procedures for a thoracic paraspinal space-occupying lesion and over 5 days had received unfractionated sodium heparin by subcutaneous injection. The pedal pulses were no longer palpable.


METHODS
The thrombocyte count had fallen from 207,000/microliter to 45,000/microliter. Angiography revealed occlusion of the common femoral artery. Heparin-induced platelet aggregation (HIPA) test demonstrated type II heparin-induced thrombocytopenia. Thrombectomy was performed and intraoperatively an i.v. bolus of the recombinant hirudin, lepirudin (Refludan), was given (0.2 mg/kg body weight), continual lepirudin infusion being continued postoperatively. Normal blood flow was re-established in the limb and the pedal pulse was palpable. There were no complications.


CONCLUSIONS
Recombinant hirudin is the only alternative licensed in Germany to heparin and seem to be suitable also for the intraoperative bolus administration in heparin-induced thromboembolic vascular occlusions.
Schmidt
O
O
Chirurgische Klinik mit Poliklinik, Universität Erlangen-Nürnberg.
Lang
W
W
D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D024764:Hirudin Therapy; D006629:Hirudins / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007430:Intraoperative Care; D007511:Ischemia / Q000188:drug therapy*; D007866:Leg / Q000098:blood supply*; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D010976:Platelet Count; D011182:Postoperative Care; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D017131:Thrombectomy; D013921:Thrombocytopenia / Q000139:chemically induced*
D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin