title: Massive pulmonary embolism due to late-onset heparin-induced thrombocytopenia following coronary artery bypass graft surgery: successful treatment with lepirudin.
abstract: Most cardiac surgical patients have had previous exposure to heparin for diagnostic or therapeutic interventions and hence have an increased susceptibility to developing heparin-induced thrombocytopenia (HIT) postoperatively. HIT is an immune-mediated adverse drug reaction that may be associated with limb or life-threatening thrombosis. Heparin cessation is a vital first step in treatment; however, alternative anticoagulant therapy is essential. Recombinant hirudin (lepirudin), a thrombin-specific inhibitor, provides safe and effective anticoagulation in such patients. We describe a case of delayed onset HIT with resulting massive pulmonary embolism postcardiac surgery that was successfully managed with lepirudin.
authors.affiliation: Division of Cardiac Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom. balaji@talk21.com
authors.forename: Balaji
authors.initials: B
authors.lastname: Badmanaban
authors.forename: Anand
authors.initials: A
authors.lastname: Sachithanandan
authors.forename: Ian
authors.initials: I
authors.lastname: Hunter
authors.forename: Alastair
authors.initials: A
authors.lastname: Graham
authors.forename: Mazin
authors.initials: M
authors.lastname: Sarsam
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin