Use of bivalirudin, a direct thrombin inhibitor, and its reversal with modified ultrafiltration during heart transplantation in a patient with heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia (HIT) is an increasingly common clinical finding in patients presenting for cardiac transplantation. Bivalrudin, a reversible direct thrombin inhibitor, is a molecular anti-coagulant with short half-life and the potential for removal by intraoperative hemofiltration. Herein we describe the dosing and intraoperative management of bivalrudin anti-coagulation in a patient undergoing urgent cardiac transplantation in the context of recently diagnosed HIT.
Mann
Michael J
MJ
Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
Tseng
Elaine
E
Ratcliffe
Mark
M
Strattman
Greg
G
De Silva
Anil
A
Demarco
Teresa
T
Achorn
Nancy
N
Moskalik
William
W
Hoopes
Charles
C
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000601:surgery; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006440:Hemofiltration; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D013917:Thrombin / Q000378:metabolism*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy*
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; D013917:Thrombin; C074619:bivalirudin