title: Perioperative care in an adolescent patient with heparin-induced thrombocytopenia for placement of a cardiac assist device and heart transplantation: case report and literature review.
abstract: Heparin-induced thrombocytopenia (HIT) can cause life-threatening complications following the administration of heparin. Discontinuation of all sources of heparin exposure and the use of alternative agents for anticoagulation are necessary when HIT is suspected or diagnosed. We present the successful use of bivalirudin anticoagulation in an adolescent patient during cardiopulmonary bypass who underwent both placement of a left ventricular assist device and subsequent heart transplantation within a 36-hour period. The pathophysiology and diagnosis of HIT are reviewed, previous reports of the use of direct thrombin inhibitors for cardiac surgery are presented, and potential dosing regimens for bivalirudin are discussed.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital.
authors.forename: Mineto
authors.initials: M
authors.lastname: Kamata
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine.
authors.forename: Roby
authors.initials: R
authors.lastname: Sebastian
authors.affiliation: Department of Cardiothoracic Surgery, Nationwide Children's Hospital.
authors.forename: Patrick I
authors.initials: PI
authors.lastname: McConnell
authors.affiliation: Cardiovascular Perfusion Services and Heart Center, Nationwide Children's Hospital and The Ohio State University.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gomez
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine.
authors.forename: Aymen
authors.initials: A
authors.lastname: Naguib
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
keywords: anticoagulation; bivalirudin; cardiopulmonary bypass; heart transplant