Cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia II and impaired renal function using heparin and the platelet GP IIb/IIIa inhibitor tirofiban as anticoagulant.
In a patient with heparin-induced thrombocytopenia II and impaired renal function, anticoagulation during cardiopulmonary bypass was successfully performed by the use of unfractionated heparin and the platelet glycoprotein IIb/IIIa inhibitor tirofiban. Postoperative antithrombotic therapy with recombinant hirudin was immediately initiated. This regimen for anticoagulation for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia II appears to be particularly appropriate for patients with impaired renal function or for hospitals without special experience with other alternative anticoagulation strategies.
Koster
A
A
Department of Anesthesia, Deutsches Herzzentrum Berlin. koster@dhzb.de
Loebe
M
M
Mertzlufft
F
F
Kuppe
H
H
Hetzer
R
R
D002315:Cardiopulmonary Bypass; D004359:Drug Therapy, Combination; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D007677:Kidney Function Tests; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011182:Postoperative Care; D011475:Prosthesis Failure; D011994:Recombinant Proteins / Q000008:administration & dosage; D012086:Reoperation; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy; D000077466:Tirofiban; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D006629:Hirudins; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D014443:Tyrosine; D006493:Heparin; D000077466:Tirofiban