title: [Fulminant coagulopathy after bivalirudin use in a patient diagnosed with heparin-induced thrombocytopenia and subject to cardiac bypass surgery].
abstract: Patients with a previous history of heparin-induced thrombocytopenia are at a higher risk for thromboembolic events, and heparin administration is formally contraindicated. Bivalirudin has been reported as an alternative therapy whenever an intervention that requires systemic anticoagulation and cardiopulmonary by-pass pump is needed. We present the case of a patient diagnosed with heparin-induced thrombocytopenia and heparin-PF4 (+) antibodies requiring a triple cardiac valve replacement who developed fulminant coagulopathy after bivalirudin administration. A discussion on the serious difficulties that the management of these types of patients involves, as well as a review of prevention strategies are presented.
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Complejo Hospitalario de León, León, España. Electronic address: blancaprada@hotmail.com.
authors.forename: B
authors.initials: B
authors.lastname: de Prada Martín
authors.affiliation: Servicio de Cirugía Cardiovascular, Complejo Hospitalario de León, León, España.
authors.forename: J
authors.initials: J
authors.lastname: Gualis Cardona
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Complejo Hospitalario de León, León, España.
authors.forename: I
authors.initials: I
authors.lastname: Pérez Blanco
authors.affiliation: Servicio de Cirugía Cardiovascular, Complejo Hospitalario de León, León, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Martínez Comendador
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D000991:Antithrombins / Q000009:adverse effects*; D016063:Blood Loss, Surgical; D001026:Coronary Artery Bypass; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced*; D057915:Drug Substitution; D017809:Fatal Outcome; D006333:Heart Failure / Q000150:complications; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins / Q000009:adverse effects*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007431:Intraoperative Complications / Q000139:chemically induced*; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D010446:Peptide Fragments / Q000009:adverse effects*; D010978:Platelet Factor 4 / Q000276:immunology*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000139:chemically induced*; D011994:Recombinant Proteins / Q000009:adverse effects; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D007074:Immunoglobulin G; D010446:Peptide Fragments; D011994:Recombinant Proteins; D010978:Platelet Factor 4; D006493:Heparin; C074619:bivalirudin
keywords: Bivalirudin; Bivalirudina; Cardiopulmonary bypass; Circulación extracorpórea; Fallo renal; Heparin-induced thrombocytopenia; Renal failure; Trombopenia inducida por heparina