title: Hirudin for management of heparin-induced thrombocytopenia type II in a patient with biventricular assist device support.
abstract: A patient with severe dilated cardiomyopathy developed heparin-induced thrombocytopenia type II (HIT II) after implantation of a biventricular assist device (biVAD). Because the patient showed mild renal dysfunction but severe hepatic impairment, the management of anticoagulation was switched from heparin to the direct thrombin inhibitor hirudin, which was administered by continuous infusion of 0.6 to 1 mg/h. This protocol was monitored by measuring the plasma hirudin level, which ranged from 0.5 to 1.5 microg/mL. Unfortunately, the patient died on day 22 after implantation from fulminant sepsis caused by Aspergillus fumigatus. Neither thromboembolic events nor thrombocytopenia was observed after hirudin administration. The explanted biVAD showed no thrombotic material in the arterial/venous lines or on the polyurethane valves. We discuss the challenges posed by HIT II complicating VAD support as well as its clinical management with direct thrombin inhibitors.
authors.affiliation: Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Vogt
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Marion
authors.initials: M
authors.lastname: Weis
authors.forename: Ralf
authors.initials: R
authors.lastname: Sodian
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Florian
authors.initials: F
authors.lastname: Weis
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects; D017809:Fatal Outcome; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006629:Hirudins; D006493:Heparin