title: The use of argatroban for carotid endarterectomy in heparin-induced thrombocytopenia.
abstract: Heparin-induced thrombocytopenia (HIT) is a major obstacle in cardiovascular surgeries. In this case report, we used argatroban, a direct thrombin inhibitor, to achieve and maintain anticoagulation for carotid endarterectomy. Unlike heparin, the direct thrombin inhibitors bind directly to thrombin, bypassing antithrombin III and the potential to precipitate HIT. A bolus of argatroban 150 microg/kg followed by an infusion of 5 microg . kg(-1) . min(-1) was used, and adequate anticoagulation was demonstrated with multiple laboratory tests (at 28 min, prothrombin time = 29.8 s, partial thromboplastin time = 69.1 s, international normalized ratio = 3.52 s, and activated clotting time = 220 s). The surgery was successful, and the patient was discharged the next day with no postoperative neurologic sequelae or other complications. We conclude that argatroban can be used safely and successfully for carotid endarterectomy in a patient with a history of HIT.
authors.affiliation: *Department of Anesthesia and Perioperative Medicine, †Division of Vascular Surgery, ‡Department of Pharmacy Services, Childrens Hospital, Medical University of South Carolina, Charleston.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hallman
authors.forename: Latha
authors.initials: L
authors.lastname: Hebbar
authors.forename: Jay
authors.initials: J
authors.lastname: Robison
authors.forename: Walter E
authors.initials: WE
authors.lastname: Uber
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001120:Arginine / Q000031:analogs & derivatives; D001780:Blood Coagulation Tests; D016894:Endarterectomy, Carotid; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D010875:Pipecolic Acids / Q000627:therapeutic use*; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban