title: Severe argatroban-induced coagulopathy in a patient with a history of heparin-induced thrombocytopenia.
abstract: Heparin-induced thrombocytopenia is a serious complication of heparin therapy, and it remains a therapeutic challenge in the subset of patients requiring cardiopulmonary bypass. Alternative anticoagulation strategies include lepirudin, danaparoid, bivalirudin, and argatroban, or a combination of unfractionated heparin with a platelet antagonist. Argatroban is eliminated by a hepatic route, making it a practical option for patients with renal insufficiency. However, the lack of an effective antidote poses a significant problem. We present a patient with a history of heparin-induced thrombocytopenia with thrombosis who underwent a redo aortic valve replacement. Although the level of anticoagulation achieved with argatroban was initially adequate, its persistence after the completion of cardiopulmonary bypass proved to be life threatening.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Gasparovic
authors.forename: Nadia S
authors.initials: NS
authors.lastname: Nathan
authors.forename: Daniel
authors.initials: D
authors.lastname: Fitzgerald
authors.forename: Sary F
authors.initials: SF
authors.lastname: Aranki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001120:Arginine / Q000031:analogs & derivatives; D001778:Blood Coagulation Disorders / Q000139:chemically induced*; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010875:Pipecolic Acids / Q000009:adverse effects*; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced*; D013927:Thrombosis / Q000139:chemically induced
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban