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.
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.
Avery
Edwin G
EG
Department of Anesthesia and Critical Care, Massachusetts General Hospital Heart Center, 55 Fruit St., Boston, MA 02114, USA. eavery@partners.org
Hilgenberg
Alan D
AD
Cambria
Richard P
RP
Beckerly
Rena
R
Donnelly
Anne M
AM
Laposata
Michael
M
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
D000925:Anticoagulants; D001323:Autoantibodies; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D010978:Platelet Factor 4; D006493:Heparin; C074619:bivalirudin