Bivalirudin anticoagulation for a patient with hypercoagulable immune syndromes undergoing mitral valve surgery.
Unfractionated heparin has been a near universal anticoagulant for cardiac surgery; however it is contraindicated in heparin-induced thrombocytopenia type II. Alternative anticoagulants such as bivalirudin (a direct thrombin inhibitor) are being utilized. Bivalirudin was successfully used in an immunologically complex patient (diagnoses of heparin-induced thrombocytopenia type II, systemic lupus erythematosus, antiphospholipid syndrome, and dialysis-dependent renal failure) requiring cardiopulmonary bypass. Thrombotic events are common in antiphospholipid syndrome patients undergoing cardiac surgery utilizing high-dose heparin. This may represent unrecognized heparin-induced thrombocytopenia type II. Our patient did not experience perioperative thrombotic or bleeding complications. The possible cross-reactivity between heparin induced thrombocytopenia type II and antiphospholipid syndrome has not been investigated.
Cain
Rebecca L
RL
Department of Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298-0695, USA. rebeccs13@aol.com
Spiess
Bruce D
BD
Nelson
Mark
M
Deanda
Abe
A
McCarthy
Harry L
HL
Green
Jeffrey A
JA
D000328:Adult; D000918:Antibody Specificity; D000925:Anticoagulants / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D003429:Cross Reactions; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006629:Hirudins / Q000276:immunology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D010446:Peptide Fragments / Q000276:immunology / Q000627:therapeutic use*; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000187:drug effects / Q000276:immunology; D011994:Recombinant Proteins / Q000276:immunology / Q000627:therapeutic use; D006435:Renal Dialysis; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology; D019851:Thrombophilia / Q000188:drug therapy* / Q000209:etiology; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D001323:Autoantibodies; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D010978:Platelet Factor 4; D014859:Warfarin; D006493:Heparin; C074619:bivalirudin