Budd--Chiari syndrome and heparin-induced thrombocytopenia.
We report on a patient suffering from Budd--Chiari disease who developed heparin-induced thrombocytopenia preoperatively. Dorsocranial liver resection and hepatoatrial anastomosis were performed with the extracorporeal circulation and perioperative anticoagulation was achieved with r-hirudin. Surprisingly, thrombus formation was observed in the venous reservoir although ACT was 590 s and aPTT 55 s. An additional bolus of hirudin and rinsing the reservoir allowed unproblematic discontinuation of the cardiopulmonary bypass.
Carrel
T
T
Clinic for Cardiovascular Surgery, University Hospital, CH-3010 Berne, Switzerland. thierry.carrel@insel.ch
Berdat
P
P
Schmidli
J
J
Gygax
E
E
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D006502:Budd-Chiari Syndrome / Q000150:complications* / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects*; D024764:Hirudin Therapy; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D013921:Thrombocytopenia / Q000139:chemically induced*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin