title: Protracted bleeding after hirudin anticoagulation for cardiac surgery in a patient with HIT II and chronic renal failure.
abstract: Heparin-induced thrombocytopenia type II (HIT II) requires alternative anticoagulation. Hirudin has been effectively used in patients with HIT II scheduled for cardiac surgery. However, bleeding complications were observed in patients with renal impairment. In vitro hemodialysis (HD) has been questioned over its efficacy in eliminating hirudin. Another approach to stop bleeding is the application of recombinant factor VIIa (rFVIIa). We report on a patient with HIT II and chronic renal failure who suffered from severe hirudin-induced bleeding after cardiac surgery who was safely treated with a combined approach of surgical hemostasis, substitution of blood products, HD, and rFVIIa to stop finally bleeding.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité University Hospital Berlin, Campus Mitte, Berlin, Germany. ortrud.vargas@charite.de
authors.forename: Ortrud Vargas
authors.initials: OV
authors.lastname: Hein
authors.forename: Christian
authors.initials: C
authors.lastname: von Heymann
authors.forename: Stanislao
authors.initials: S
authors.lastname: Morgera
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Konertz
authors.forename: Sabine
authors.initials: S
authors.lastname: Ziemer
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology*; D006493:Heparin / Q000009:adverse effects; D024764:Hirudin Therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D013921:Thrombocytopenia / Q000150:complications* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006493:Heparin