Bivalirudin for anticoagulation in mechanical aortic valve replacement and heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia (HIT) is a potentially serious syndrome. Since there are some alternatives to treatment with heparin in patients who develop HIT, the decision as to which to use should be based on renal and hepatic function, drug availability and the available monitoring resources. We report a patient who received heparin for mechanical aortic valve replacement. Her clinical course was complicated by HIT, which was treated initially by danaparoid. The syndrome progressed with new thrombotic complications, and eventually was treated successfully by bivalirudin (Angiomax; Medison Pharma Ltd, Petach Tikva, Israel) for 9 days. We propose that treatment with bivalirudin for several days is a safe and effective alternative to heparin therapy in patients who develop HIT.
Klein
Moti
M
Department of Critical Care, Division of Anesthesiology and Critical Care, Israel. motiklein@yahoo.com
Tomer
Aaron
A
Swartz
Andre
A
Koyffman
Leonid
L
Weksler
Natan
N
D000925:Anticoagulants / Q000008:administration & dosage*; D001021:Aortic Valve / Q000637:transplantation*; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D010976:Platelet Count; D011994:Recombinant Proteins / Q000008:administration & dosage; D013577:Syndrome; D013921:Thrombocytopenia / Q000150:complications / Q000188:drug therapy*
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin