title: Successful use of bivalirudin for combined carotid endarterectomy and coronary revascularization with the use of cardiopulmonary bypass in a patient with an elevated heparin-platelet factor 4 antibody titer.
abstract: We report a combined carotid endarterectomy and coronary revascularization surgery with cardiopulmonary bypass using bivalirudin for systemic anticoagulation in a patient with a positive titer for the heparin-platelet factor 4 antibody. The patient experienced procedural success for both the carotid and coronary surgeries. Increased blood and blood product transfusion was required postoperatively.
authors.affiliation: Department of Anesthesia and Critical Care, Massachusetts General Hospital Heart Center, 55 Fruit St., Boston, MA 02114, USA. eavery@partners.org
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Avery
authors.forename: Alan D
authors.initials: AD
authors.lastname: Hilgenberg
authors.forename: Richard P
authors.initials: RP
authors.lastname: Cambria
authors.forename: Rena
authors.initials: R
authors.lastname: Beckerly
authors.forename: Anne M
authors.initials: AM
authors.lastname: Donnelly
authors.forename: Michael
authors.initials: M
authors.lastname: Laposata
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood*; D001777:Blood Coagulation / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000276:immunology / Q000601:surgery*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000276:immunology / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D010978:Platelet Factor 4 / Q000276:immunology*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D001323:Autoantibodies; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D010978:Platelet Factor 4; D006493:Heparin; C074619:bivalirudin