[Use of Organon, a synthetic heparinoid, in two cardiopulmonary bypass procedures in the same patient sensitive to heparin].
We report the case of a patient who underwent two cardiopulmonary bypass (CPB) procedures with Orgaran because of heparin-induced thrombocytopenia. A 38 years-old man with ischemic mitral insufficiency was operated for coronary artery bypass and valvular replacement. The CPB was carried out with heparin. Heparin-induced thrombocytopenia occured and was proven immunologically. Two months later, a new valvular replacement was performed because of paravalvular leak due to endocarditis. The Orgaran-CPB protocol was as follows: 5,000 units before cardiopulmonary bypass, 5,000 units in the priming volume, anti-Xa level between 0.9 and 1.1 units/mL, with injection of 1,500 units if necessary, no administration of protamine. One month later, a new valvular replacement was necessary and performed with the same protocol using Orgaran. No bleeding or thrombotic complication occurred. Orgaran is a safe and reliable anti-thrombotic substitute if anti-Xa activity is closely monitored.
Pineau
E
E
Département cardiovasculaire, Institut mutualiste Montsouris, 42, boulevard Jourdan, 75674 Paris.
Le Bret
E
E
Folliguet
T
T
Saint Maurice
O S
OS
Carbognani
D
D
Laborde
F
F
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003871:Dermatan Sulfate / Q000627:therapeutic use*; D004696:Endocarditis / Q000209:etiology* / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000009:adverse effects*; D006494:Heparin Antagonists / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011475:Prosthesis Failure; D011479:Protamines / Q000627:therapeutic use; D012086:Reoperation; D013921:Thrombocytopenia / Q000139:chemically induced*; D016896:Treatment Outcome
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006493:Heparin; D006494:Heparin Antagonists; D006497:Heparan Sulfate; D011479:Protamines; C035838:danaparoid