title: Anticoagulation in extracorporeal circulation using recombinant hirudin: a case report.
abstract: Heparin-induced thrombocytopenia (HIT) is a severe complication following the application of heparin; antibodies against complexes of heparin and PDF4 initiate activation of platelets. This may lead to massive thrombembolism, which is associated with a slight and transient drop of platelets in HIT I or a drop below 50% after approximately 5 days in HIT II. Further administration of heparin has to be strictly avoided in these patients. Immunologic evidence for HIT can easily be obtained by the heparin-induced platelet aggregation assay. If anticoagulation is necessary, different, alternative drugs are available. Recombinant hirudin (r-hirudin) is a well-established drug for safe anticoagulation. Monitoring is possible by estimating the plasma level of r-hirudin from the ecarin-clotting time. We report a case of a patient with prosthetic aortic valve endocarditis and HIT II who suffered from massive postoperative bleeding requiring massive substitution of blood components and coagulants caused by free circulating r-hirudin due to the use of a hemofilter.
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Diabetes Center Mecklenburg-Vorpommern, Klinikum Karlsburg, Germany. svenbeholz@aol.com
authors.forename: S
authors.initials: S
authors.lastname: Beholz
authors.forename: H
authors.initials: H
authors.lastname: Grubitzsch
authors.forename: B
authors.initials: B
authors.lastname: Bergmann
authors.forename: H G
authors.initials: HG
authors.lastname: Wollert
authors.forename: L
authors.initials: L
authors.lastname: Eckel
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D016063:Blood Loss, Surgical; D004696:Endocarditis / Q000209:etiology; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000009:adverse effects* / Q000379:methods; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006440:Hemofiltration / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D013921:Thrombocytopenia / Q000139:chemically induced / Q000209:etiology
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins