Alternative anticoagulation during cardiovascular procedures in pediatric patients with heparin-induced thrombocytopenia.
Patients with heparin-induced thrombocytopenia (HIT) that require anticoagulation for cardiovascular procedures represent a challenging and high-risk group. Bivalirudin and argatroban have been successfully used as alternative anticoagulants in adult patients with HIT. There have been few experiences published involving the pediatric population and controversy exists regarding the properties and optimal dosing of these drugs. This report describes the experience of managing two pediatric patients with HIT that underwent cardiovascular procedures requiring anticoagulation. Bivalirudin was used in both cases for anticoagulation during cardiopulmonary bypass, while argatroban was used without complications during cardiac catheterization. A description of perfusion and anticoagulation protocols is included.
The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida 32806, USA.
I Ricardo
IR
Argueta-Morales
Monica C
MC
Olsen
William M
WM
DeCampli
Hamish M
HM
Munro
Donald E
DE
Felix
D000991:Antithrombins / Q000008:administration & dosage*; D001120:Arginine / Q000031:analogs & derivatives; D002315:Cardiopulmonary Bypass; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage*; D010875:Pipecolic Acids / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced*
D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban; C074619:bivalirudin