Argatroban as an alternative anticoagulant for patients with heparin allergy during coronary bypass surgery.
Although heparin allergy is a rare but well-documented entity, anticoagulation management for cardiac surgery in patients with the heparin allergy has not been established due to its rarity. Here we report a case that shows our anticoagulation strategy during a coronary bypass operation. A 67-year-old man with unstable angina pectoris developed an urticarial rash 10 h after the second exposure to heparin. Results of the drug lymphocyte stimulation test were positive for porcine heparin, coumadin, and nicorandil. Off-pump coronary bypass surgery was successfully performed with argatroban as an alternative anticoagulant to heparin, with activated clotting time kept over 200 s at the rate of 5 microg/kg per min of argatroban infusion.
Ohno
Hideaki
H
Department of Cardiovascular Surgery, National Yokohama Hospital, 3-60-2 Harajuku, Totsuka-ku, Yokohama 245-8575, Japan. bypasurg@yokohama.hosp.go.jp
Higashidate
Masafumi
M
Yokosuka
Tatsuya
T
D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001120:Arginine / Q000031:analogs & derivatives; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D010875:Pipecolic Acids / Q000494:pharmacology*; D013449:Sulfonamides
D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban