title: Cardiac surgery in a patient with heparin-induced thrombocytopenia--cautions with use of the direct thrombin inhibitor, argatroban.
abstract: Heparin-induced thrombocytopenia (HIT) is being recognized in an increasing number of patients referred for cardiac surgery, as a result of previous exposure to heparin. We present a case of a patient with HIT scheduled for aortic valve replacement and coronary bypass graft surgery, who was managed with the direct thrombin inhibitor, argatroban for anticoagulation during cardiopulmonary bypass (CPB). The patient sustained continued bleeding in excess of the acknowledged half-life of the drug and required a substantial number of blood products to restore coagulation following CPB. Pertinent reports using argatroban for cardiac surgery with CPB are reviewed in the context of the present case report. The pharmacologic basis, cost analysis and resource utilization of heparin substitutes are discussed for the patient with HIT requiring CPB.
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510-8051, USA. viji.kurup@yale.edu
authors.forename: Viji
authors.initials: V
authors.lastname: Kurup
authors.forename: Sarah
authors.initials: S
authors.lastname: Transue
authors.forename: Yanyun
authors.initials: Y
authors.lastname: Wu
authors.forename: Henry M
authors.initials: HM
authors.lastname: Rinder
authors.forename: Paul
authors.initials: P
authors.lastname: Barash
authors.forename: Michael
authors.initials: M
authors.lastname: Dewar
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001024:Aortic Valve Stenosis / Q000601:surgery; D001120:Arginine / Q000031:analogs & derivatives; D000075202:Contraindications; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000493:pharmacokinetics; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000188:drug therapy; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D010975:Platelet Aggregation Inhibitors; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban