title: Plasma-modified ACT can be used to monitor bivalirudin (Angiomax) anticoagulation for on-pump cardiopulmonary bypass surgery in a patient with heparin-induced thrombocytopenia.
abstract: Heparin-induced thrombocytopenia (HIT) is a problem of growing significance and concern, affecting an estimated 1-3% of patients among those receiving an estimated 10 million heparin exposures annually in the United States. The prevalence of heparin antibodies has been reported as at least 12.7% in the general cardiac surgery population before surgery and 42% following surgery. Various management techniques for anticoagulation in these patients have been proposed. Many of these alternative agents present additional risks for bleeding and efficacy and, furthermore, require the use of nonconventional monitoring assays to assess the level of anticoagulation achieved adequately. We report here the successful use of bivalirudin anticoagulation on pump, with no additional morbidity, and the first reported use of the plasma-modified ACT (activated clotting time) test, a simple modification of the standard ACT assay, to monitor the anticoagulant effect of bivalirudin.
authors.affiliation: Cardiovascular Perfusion Services, The Medical Center of Central Georgia, Macon, Georgia 31201-2155, USA. Jabr.Karim@mccg.org
authors.forename: Karim
authors.initials: K
authors.lastname: Jabr
authors.forename: Joe H
authors.initials: JH
authors.lastname: Johnson
authors.forename: Miles H
authors.initials: MH
authors.lastname: McDonald
authors.forename: Diane L
authors.initials: DL
authors.lastname: Walsh
authors.forename: William D
authors.initials: WD
authors.lastname: Martin
authors.forename: Anton C
authors.initials: AC
authors.lastname: Johnson
authors.forename: John M
authors.initials: JM
authors.lastname: Pickett
authors.forename: Usha
authors.initials: U
authors.lastname: Shantha-Martin
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology; D001777:Blood Coagulation / Q000187:drug effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D016903:Drug Monitoring; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000031:analogs & derivatives* / Q000494:pharmacology*; D006801:Humans; D010446:Peptide Fragments / Q000494:pharmacology* / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000494:pharmacology* / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000517:prevention & control*; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin