title: Successful implantation of a left ventricular assist device in a patient with heparin-induced thrombocytopenia and thrombosis.
abstract: We report the case of a 27-year-old woman with signs of heparin-induced thrombocytopenia and thrombosis (HITT) and left heart failure presenting for urgent implantation of a left ventricular assist device (LVAD). HITT can occur in 4.2-6.1% of patients with LVADs. If the patient remains hemodynamically stable, implantation can be delayed for several months until the heparin/PF-4 antibodies decline allowing the use of heparin on cardiopulmonary bypass, However, in most cases related to cardiogenic shock, surgery cannot be delayed. We present the case of a patient who underwent implantation of a HeartMate II LVAD and discuss management strategy using bivalirudin during cardiopulmonary bypass.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Garland
authors.forename: David
authors.initials: D
authors.lastname: Somogyi
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use; D019919:Prosthesis Implantation / Q000379:methods; D011994:Recombinant Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D013927:Thrombosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin