title: Deep hypothermic circulatory arrest and bivalirudin use in a patient with heparin-induced thrombocytopenia and antiphospholipid syndrome.
abstract: BACKGROUND
  Patients with heparin-induced thrombocytopenia II (HIT II) need an alternative nonheparin-based method of anticoagulation for cardiopulmonary bypass (CPB) to prevent thrombosis and thrombosis related complications.
  
  
  METHODS
  Bivalirudin was used during CPB and deep hypothermic circulatory arrest (DHCA) for resection of multiple right atrial masses in a patient with HIT II and antiphospholipid antibodies syndrome (APS). Anticoagulation was monitored with the activated clotting time (ACT) and a target ACT of 450 seconds or greater was maintained.
  
  
  RESULTS
  Surgical removal of multiple right atrial masses was successful and there was no evidence of thromboembolic events. Clot was noticed in the cardiotomy and venous reservoir after CPB was discontinued and the system flushed. The postoperative course was uneventful.
  
  
  CONCLUSIONS
  Anticoagulation was successfully managed with bivalirudin, a new short-acting, and direct thrombin inhibitor. Further studies are necessary to evaluate the safety of bivalirudin during DHCA.
authors.affiliation: Department of Anesthesiology, Boston University Medical Center, Boston University, Boston, Massachusetts 02118, USA. kbleissner@yahoo.com
authors.forename: Kay B
authors.initials: KB
authors.lastname: Leissner
authors.forename: Ara
authors.initials: A
authors.lastname: Ketchedjian
authors.forename: Richard
authors.initials: R
authors.lastname: Crowley
authors.forename: Rafael
authors.initials: R
authors.lastname: Ortega
authors.forename: Jan F
authors.initials: JF
authors.lastname: Hesselvik
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shemin
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000517:prevention & control; D000991:Antithrombins / Q000008:administration & dosage / Q000627:therapeutic use; D001777:Blood Coagulation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D006325:Heart Atria; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D009232:Myxoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010446:Peptide Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000517:prevention & control; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin