title: Anticoagulation with bivalirudin during deep hypothermic circulatory arrest in a patient with heparin-induced thrombocytopenia.
abstract: Heparin-induced thrombocytopenia is a well-recognized complication of anticoagulation with heparin. We present the case of a patient with recent heparin-induced thrombocytopenia who subsequently needed surgery on an emergency basis for acute type A aortic dissection. This article reports the successful use of bivalirudin, a direct thrombin inhibitor, as an alternative to heparin throughout cardiopulmonary bypass and deep hypothermic circulatory arrest. We contend that bivalirudin is a safe alternative to heparin when performing surgery for aortic dissection and should be considered as an option for use in patients who present with heparin-induced thrombocytopenia.
authors.forename: Agamemnon
authors.initials: A
authors.lastname: Pericleous
authors.forename: Mostafa
authors.initials: M
authors.lastname: Sadek
authors.forename: Mary
authors.initials: M
authors.lastname: Fitzmaurice
authors.forename: Constance
authors.initials: C
authors.lastname: Caldwell
authors.forename: Kris
authors.initials: K
authors.lastname: Natividad
authors.forename: Konstadinos A
authors.initials: KA
authors.lastname: Plestis
mesh_terms: D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D000925:Anticoagulants / Q000008:administration & dosage* / Q000276:immunology; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D000075202:Contraindications; D004334:Drug Administration Schedule; D004630:Emergencies; D006493:Heparin / Q000276:immunology; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: Anticoagulants/adverse effects; aortic dissection; bivalirudin; blood coagulation; blood loss, surgical; cardiopulmonary bypass; circulatory arrest, deep hypothermia induced; hemofiltration; heparin/adverse effects; hirudins; thrombocytopenia/chemically induced/prevention & control