Hirudin as anticoagulant for cardiopulmonary bypass: importance of preoperative renal function.
BACKGROUND
Recombinant hirudin is an alternative anticoagulant for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II. Although there is no neutralizing agent for recombinant hirudin, its fast renal elimination enables quick cessation of bleeding after cardiopulmonary bypass. The aim of the study was to compare anticoagulant effects of recombinant hirudin in regards to renal function in patients with heparin-induced thrombocytopenia type II.


METHODS
Twenty-one patients (mean age, 65 years, and range, 35 to 82 years) underwent different complex cardiovascular procedures using recombinant hirudin as the anticoagulant for cardiopulmonary bypass. Postoperative blood loss, transfusion requirements, and hemostatic variables were compared between patients with a creatinine level lower than 1.5 mg/dL (group 1, normal renal function; n = 17 patients) and those with a creatinine level greater than 1.5 mg/dL (group 2, impaired renal function; n = 4 patients).


RESULTS
The patients in group 1 showed no increased tendency toward postoperative bleeding. In contrast, all 4 patients in group 2 required reexploration for increased postoperative bleeding. They had higher activated partial thromboplastin times and transfusion requirements postoperatively.


CONCLUSIONS
If recombinant hirudin is used as the anticoagulant for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II and impaired renal function, the risk of postoperative bleeding is increased.
Koster
A
A
Deutsches Herzzentrum Berlin, Germany.
Pasic
M
M
Bauer
M
M
Kuppe
H
H
Hetzer
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D000991:Antithrombins / Q000378:metabolism / Q000627:therapeutic use*; D007611:Aprotinin / Q000627:therapeutic use; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000097:blood; D004231:Diuresis / Q000502:physiology; D005260:Female; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects; D024764:Hirudin Therapy; D006629:Hirudins / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000502:physiology*; D007674:Kidney Diseases / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D019106:Postoperative Hemorrhage / Q000209:etiology; D011994:Recombinant Proteins; D012307:Risk Factors; D015996:Survival Rate; D013921:Thrombocytopenia / Q000139:chemically induced
D000925:Anticoagulants; D000991:Antithrombins; D006490:Hemostatics; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; D007611:Aprotinin; D003404:Creatinine