[Anesthetic management for a patient with heparin-induced thrombocytopenia (HIT) undergoing off-pump coronary bypass surgery using argatroban, a direct thrombin inhibitor].
HIT type II is one of the severe complications of heparin therapy. The antibody for the heparin-PF 4 complex, which causes thrombocytopenia of less than 100 x 10(3) microl(-1), thrombosis and DIC-like symptoms, is produced. We managed the patient with HIT type II undergoing off-pump CABG. Anesthesia was induced and maintained with fentanyl, midazolam, vecuronium and sevoflurane. The operation was performed using argatroban, a direct thrombin inhibitor, as an anticoagulant. Intraoperative activated coagulation time (ACT) was maintained above 250 sec with 2.5-5.0 microg x kg(-1) x min(-1) of argatroban infusion without bolus injection and all the procedures were successful.
Saito
Tomoyuki
T
Department of Anesthesiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya 343-8555.
Uchida
Eriko
E
Saima
Shunsuke
S
Chiba
Ayako
A
Arai
Takero
T
Okuda
Yasuhisa
Y
D000368:Aged; D000758:Anesthesia; D000787:Angina Pectoris / Q000601:surgery; D000925:Anticoagulants / Q000008:administration & dosage*; D001120:Arginine / Q000031:analogs & derivatives; D047549:Coronary Artery Bypass, Off-Pump; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D008297:Male; D010875:Pipecolic Acids / Q000008:administration & dosage*; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced*
D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban