Successful use of bivalirudin for cardiopulmonary bypass in a patient with heparin allergy.
Heparin-induced IgE-mediated hypersensitivity and anaphylactoid reactions, although rare, can pose a serious clinical problem for patients requiring cardiopulmonary bypass (CPB). Bivalirudin is a bivalent reversible direct thrombin inhibitor, with a half-life of 25 min, eliminated mostly by proteolytic cleavage. There are some reports on the use of bivalirudin for cardiac surgery, particularly for heparin-induced thrombocytopenia (HIT), but none on cases of heparin allergy. We report a case of heparin allergy successfully managed for CPB with bivalirudin anticoagulation.
Pappalardo
F
F
Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy. pappalardo.federico@hsr.it
Franco
A
A
Crescenzi
G
G
Poli
A
A
Zangrillo
A
A
Koster
A
A
D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D004342:Drug Hypersensitivity; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D007073:Immunoglobulin E; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use
D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D007073:Immunoglobulin E; D006493:Heparin; C074619:bivalirudin