Successful use of bivalirudin as anticoagulant for ECMO in a patient with acute HIT.
A patient with myocardial failure after repair of an acute type A aortic dissection had acute heparin-induced thrombocytopenia develop during extracorporeal membrane oxygenation. Heparin was discontinued and the anticoagulant was switched to the direct thrombin inhibitor bivalirudin given with a bolus of 0.5 mg/kg followed by a continuous infusion of 0.5 mg/kg/h. Using this protocol, activated clotting time values ranged from 200 to 220 seconds. After prolonged extracorporeal membrane oxygenation support and recovery of left ventricular function, a right ventricular assist device was implanted during extracorporeal membrane oxygenation support with bivalirudin anticoagulation. For this procedure an additional bolus of 0.25 mg/kg bivalirudin was given, and the infusion rate increased to 1 mg/kg/h to achieve activated clotting time values of 300 to 350 seconds. Surgery was successfully performed with moderate intraoperative and postoperative blood loss and transfusion requirements.
Koster
Andreas
A
Department of Anesthesia, Deutsches Herzzentrum Berlin, Berlin, Germany. koster@dhzb.de
Weng
Yuguo
Y
Böttcher
Wolfgang
W
Gromann
Tom
T
Kuppe
Hermann
H
Hetzer
Roland
R
D000328:Adult; D000784:Aortic Dissection / Q000601:surgery; D000925:Anticoagulants / Q000627:therapeutic use*; D001014:Aortic Aneurysm / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D006353:Heart-Assist Devices; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced*
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin