title: Case report: a thrombus in the venous reservoir while using bivalirudin in a patient with heparin-induced thrombocytopenia undergoing heart transplantation.
abstract: Direct thrombin inhibitors are heparin alternatives for anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia. We report a case of a large thrombus forming in the venous reservoir while using bivalirudin. We suggest that blood stasis associated with the full venous reservoir maintained in this case led to formation of a large thrombus at the top of the venous canister. Furthermore, activated clotting times may not accurately reflect the magnitude of anticoagulation when using direct thrombin inhibitors.
authors.affiliation: Division of Cardiovascular Anesthesia, and Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA. wongjk2003@yahoo.co
authors.forename: Jim K
authors.initials: JK
authors.lastname: Wong
authors.forename: Ying
authors.initials: Y
authors.lastname: Tian
authors.forename: Paul
authors.initials: P
authors.lastname: Shuttleworth
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Caffarelli
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Reitz
authors.forename: Christina T
authors.initials: CT
authors.lastname: Mora-Mangano
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D000991:Antithrombins / Q000009:adverse effects* / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000601:surgery; D005342:Fibrinolysis; D016027:Heart Transplantation / Q000379:methods*; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006629:Hirudins / Q000009:adverse effects*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000009:adverse effects* / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*; D013927:Thrombosis / Q000097:blood*; D017211:Treatment Failure; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin