Heparin-induced thrombocytopenia and its related complications can be life-threatening in patients undergoing cardiopulmonary bypass (CPB) with heparin exposure. While the literature illustrates many different techniques which might be employed in this situation, most are used infrequently. This case report provides an overview of the successful use of r-Hirudin, and associated monitoring techniques, in a high-risk patient undergoing cardiac surgery utilizing CPB.