Anticoagulation for patients with heparin-induced thrombocytopenia using recombinant hirudin during cardiopulmonary bypass.
Heparin-induced thrombocytopenia (HIT) is a common complication of heparin therapy. There are three types of HIT. In the majority of patients, thrombocytopenia is modest and resolves without sequelae (HIT I). In a smaller number of patients, the thrombocytopenia is severe (HIT II), and in still others, the thrombocytopenia is also associated with thrombosis (HITT). Administration of heparin to this latter group of patients causes platelet aggregation, thromboembolism, and thrombocytopenia. It is advisable that heparin not be administered in any form to patients with documented or suspected HIT II or HITT. This situation, of course, poses a problem for those patients requiring cardiopulmonary bypass (CPB) surgery. In this report, we summarize our experience with Lepirudin (Hoechst, Frankfurt Ammain, Germany), which is a recombinant hirudin (r-hirudin), as an alternative to heparin for systemic anticoagulation, as well as the use of the ecarine clotting time (ECT) for monitoring anticoagulation status during CPB.
Liu
Hong
H
Department of Anesthesiology and Pain Medicine, University of California-Davis Medical Center, Sacramento, CA 95817, USA. hualiu@ucdavis.edu
Fleming
Neal W
NW
Moore
Peter G
PG
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin