Bleeding after intermittent or continuous r-hirudin during CVVH.
OBJECTIVE
To demonstrate bleeding complications encountered in patients after cardiac surgery on continuous venovenous haemofiltration (CVVH) treated with continuous versus intermittent r-hirudin for heparin-induced thrombocytopenia (HIT) type II.


METHODS
Case description.


METHODS
Cardiothoracic intensive care unit at a university hospital.


METHODS
5 consecutive patients with proven HIT type II on CVVH after major cardiac surgery.


METHODS
Recombinant hirudin (r-hirudin) was given continuously at a dose of 0.01 mg/kg per h in three patients or in repeated bolus administration of 0.05 mg/kg in two patients.


RESULTS
Since the ecarin clotting time assay was not available at that time to monitor hirudin effects on coagulation, the activated partial thromboplastin time (normal range 26-38 s, target range 50-60 s) was used. The continuously treated patients suffered from major bleeding complications. Therefore, the regimen was changed to repeated bolus administration, reducing the incidence of bleeding complications probably due to a threefold diminished cumulative hirudin dose per day in comparison to continuous administration.


CONCLUSIONS
If ecarin clotting time, the most suitable monitor for hirudin activation, is not available, we would prefer to give r-hirudin in repeated boluses to avoid major bleeding complications in cardiac surgery patients on CVVH.
Kern
H
H
Department of Anaesthesiology and Operative Intensive Care, University Hospital Charité, Humboldt-University Berlin, Germany. hartmut.kern@charite.de
Ziemer
S
S
Kox
W J
WJ
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects*; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D017809:Fatal Outcome; D019918:Heart Valve Prosthesis Implantation; D006440:Hemofiltration; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012086:Reoperation; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy*
D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D006493:Heparin