title: Challenging Argatroban Management of a Child on Extracorporeal Support and Subsequent Heart Transplant.
abstract: A 6-year-old child developed heparin-induced thrombocytopenia while on extracorporeal life support. Hours after a difficult transition from heparin to argatroban for anticoagulation therapy, the child underwent heart transplantation. Intraoperative management was plagued with circuit thrombus formation while on cardiopulmonary bypass and subsequent massive hemorrhage after bypass. We review the child's anticoagulation management, clinical challenges encountered, and review current literature related to the use of argatroban in pediatric cardiac surgery.
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA University of Washington School of Medicine, Seattle, WA, USA gregory.latham@seattlechildrens.org.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Latham
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Christa
authors.initials: C
authors.lastname: Jefferis Kirk
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Falconer
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Dickey
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Albers
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: David Michael
authors.initials: DM
authors.lastname: McMullan
mesh_terms: D000991:Antithrombins / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D005078:Exchange Transfusion, Whole Blood; D015199:Extracorporeal Membrane Oxygenation; D016027:Heart Transplantation; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use; D010875:Pipecolic Acids / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban; C074619:bivalirudin
keywords: HIT; anticoagulants; bivalirudin; cardiopulmonary bypass; children; coagulation; coagulopathy; congenital heart disease; hemorrhage; thrombosis