title: Delayed thrombin generation with hirudin anticoagulation during prolonged cardiopulmonary bypass.
abstract: Patients with heparin-induced thrombocytopenia requiring urgent cardiac surgery present a unique challenge that must be addressed by the use of nonheparin alternatives for anticoagulation during cardiopulmonary bypass. Although isolated cases have been presented involving the use of antithrombin III independent thrombin inhibitor hirudin in this situation, its ability to completely inhibit thrombin activity has not been demonstrated. In this report we describe the efficacy of this drug in inhibiting thrombin during a case requiring prolonged cardiopulmonary bypass.
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. frubens@ottawaheart.ca
authors.forename: Fraser D
authors.initials: FD
authors.lastname: Rubens
authors.forename: Gilbert
authors.initials: G
authors.lastname: Lavalee
authors.forename: Marc A
authors.initials: MA
authors.lastname: Ruel
authors.forename: Thierry
authors.initials: T
authors.lastname: Mesana
authors.forename: Michael
authors.initials: M
authors.lastname: Bourke
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D000075202:Contraindications; D003871:Dermatan Sulfate / Q000627:therapeutic use; D004691:Endarterectomy; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006497:Heparan Sulfate / Q000627:therapeutic use; D006629:Hirudins / Q000494:pharmacology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D010949:Plasma; D017713:Platelet Transfusion; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D017131:Thrombectomy; D013917:Thrombin / Q000037:antagonists & inhibitors* / Q000096:biosynthesis; D013921:Thrombocytopenia / Q000139:chemically induced; D013997:Time Factors; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006493:Heparin; D006497:Heparan Sulfate; D006629:Hirudins; D011994:Recombinant Proteins; D013917:Thrombin; D014859:Warfarin; C035838:danaparoid; C083544:lepirudin