title: Bivalirudin Anticoagulation for a Pediatric Patient with Heparin-Induced Thrombocytopenia and Thrombosis Requiring Cardiopulmonary Bypass for Ventricular Assist Device Placement.
abstract: The direct thrombin inhibitor bivalirudin is an option for anticoagulation in patients with heparin induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB). There are a limited number of reports of pediatric patients in which bivalirudin has been used for anticoagulation for CPB. We present the case of an 11 year old male with acute onset heart failure secondary to idiopathic dilated cardiomyopathy that developed heparin induced thrombocytopenia with thrombosis (HITT). The patient was anticoagulated in the operating room with bivalirudin and placed on CPB for insertion of a HeartWare(®) Ventricular Assist Device (Heartware(®)). Modified techniques were utilized. This included use of the Terumo CDI 500 (Terumo Cardiovascular Systems, Inc.) in-line blood gas monitor which contains a heparin coated arterial shunt sensor. We flushed this sensor with buffered saline preoperatively and noted no significant decrease in platelet count postoperatively. The patient was successfully placed on the ventricular assist device and was subsequently listed for heart transplantation.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Katie H
authors.initials: KH
authors.lastname: Faella
authors.affiliation: Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Whiting
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Matte
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000379:methods; D002648:Child; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D016027:Heart Transplantation / Q000295:instrumentation / Q000379:methods; D006353:Heart-Assist Devices; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy* / Q000601:surgery; D013927:Thrombosis / Q000139:chemically induced / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: Angiomax; HIT; HITT; anticoagulation; bivalirudin; heparin-induced thrombocytopenia; pediatric cardiopulmonary bypass; ventricular assist device