[Massive haemorrhage after bivalirudin anticoagulation in two heart transplant patients].
Heparin-induced thrombopenia is a common autoimmune complication. It is a prothrombotic state due to the formation of antibodies against heparin/platelet factor 4 complexes. In this situation drugs other than heparin must be used for anticoagulation during extracorporeal circulation (bypass) surgery. Two cases of heart transplantation are presented in whom bivalirudin was used as an anticoagulant during the cardiopulmonary bypass. Severe bleeding complications were observed in both patients. The diagnosis of heparin-induced thrombopenia needs to be improved, as well as the development of protocols for using new drugs other than heparin. For this reason, we have reviewed current protocols and alternative therapies to heparin.
Servicio de Cirugía Cardiaca, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España. Electronic address: maneltf@gmail.com.
M
M
Tauron
P
P
Paniagua
C
C
Muñoz-Guijosa
S
S
Mirabet
J M
JM
Padró
D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002315:Cardiopulmonary Bypass; D015908:Counterpulsation; D004630:Emergencies; D005112:Extracorporeal Circulation; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006629:Hirudins / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy; D010446:Peptide Fragments / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000139:chemically induced*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012770:Shock, Cardiogenic / Q000628:therapy
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin