Bidirectional glenn shunt surgery using lepirudin anticoagulation in an infant with heparin-induced thrombocytopenia with thrombosis.
There are few reports of the management of pediatric patients with heparin-induced thrombocytopenia (HIT) requiring cardiac surgery using currently available anticoagulants. We report a case of an infant with HIT requiring a bidirectional Glenn shunt who was successfully managed using lepirudin (r-hirudin, Refludan; Aventis, Bridgewater, NJ). Dosing and monitoring of anticoagulation were difficult, and we suggest caution in the use of lepirudin for cardiac surgery unless reliable monitoring of the degree of anticoagulation becomes available.
Iannoli
Ellen D
ED
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, NY, USA. Ellen_iannoli@urmc.rochester.edu
Eaton
Michael P
MP
Shapiro
Janine R
JR
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D006439:Hemodynamics; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000601:surgery; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative; D010314:Partial Thromboplastin Time; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications*; D013927:Thrombosis / Q000139:chemically induced* / Q000150:complications*
D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin