Use of bivalirudin to prevent thrombosis following orthotopic liver transplantation in a patient with Budd-Chiari syndrome and a history of heparin-induced thrombocytopenia.
Type II heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome that may arise in a time-dependent manner following heparin therapy, placing patients at significant risk for thromboembolic events. Therapy includes anticoagulation with a direct thrombin inhibitor and avoidance of heparin. We report a patient with Budd-Chiari syndrome and a history of heparin-induced thrombocytopenia who presented for orthotopic liver transplant and required postoperative anticoagulation with bivalirudin. During the post-transplant graft function improvement, we observed a significant dose-effect alteration manifested by an increased bivalirudin dose requirement as factor V activity increased. This observation is an important consideration in the attempt to maintain an optimal balance between effective anticoagulation and a reduced risk of postoperative bleeding.
Anderegg
Brent A
BA
Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Baillie
G Mark
GM
Uber
Walter E
WE
Chavin
Kenneth D
KD
Lin
Angello
A
Baliga
Prabhakar K
PK
Lazarchick
John
J
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D006502:Budd-Chiari Syndrome / Q000150:complications* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005165:Factor V / Q000378:metabolism; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D010314:Partial Thromboplastin Time; D010446:Peptide Fragments / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D005165:Factor V; D006493:Heparin; C074619:bivalirudin