The Use of r-Hirudin During Cardiopulmonary Bypass in a Patient with Heparin Induced Thrombocytopenia

Webb, David P.; Vinas, Michael S.; Drinkwater, Davis C.; Merrill, Walter H.

doi:10.1051/ject/2000322107

J Extra Corpor Technol

2000

DOI: 10.1051/ject/2000322107

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The Use of r-Hirudin During Cardiopulmonary Bypass in a Patient with Heparin Induced Thrombocytopenia

David P. Webb

Michael S. Vinas

Davis C. Drinkwater

et al.

Abstract: 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.

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“…Searching "hirudin" at www.ject.org/ yielded four more relevant references. Webb, Vinas, Drinkwater, and Merrill offered another timely r-hirudin case report in 2000 (2). Charlene Fabrizio (3) presented a case report that featured the use of the Ecarin Clotting Time and provided an educational table of currently available heparin alternatives.…”

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Classic Pages of theJournal of ExtraCorporeal Technology

Riley¹

2005

J Extra Corpor Technol

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confidence: 99%

Classic Pages of theJournal of ExtraCorporeal Technology

Riley¹

2005

J Extra Corpor Technol

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A Novel Antidote-Controlled Anticoagulant Reduces Thrombin Generation and Inflammation and Improves Cardiac Function in Cardiopulmonary Bypass Surgery

et al. 2006

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Heparin and protamine are the standard anticoagulant-antidote regimen used in almost every cardiopulmonary bypass (CPB) procedure even though both are associated with an array of complications and toxicities. Here we demonstrate that an anticoagulant aptamer-antidote pair targeting factor IXa can replace heparin and protamine in a porcine CPB model and also limit the adverse effects on thrombin generation, inflammation, and cardiac physiology associated with heparin and protamine use. These results demonstrate that targeting clotting factors upstream of thrombin in the coagulation cascade can potentially reduce the perioperative pathologies associated with CPB and suggest that the aptamer-antidote pair to FIXa may improve the outcome of patients undergoing CPB. In particular, this novel anticoagulant-antidote pair may prove to be useful in patients diagnosed with heparin-induced thrombocytopenia or those who have been sensitized to protamine, particularly patients who have insulin-dependent diabetes.

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Argatroban in Short-Term Percutaneous Ventricular Assist Subsequent to Heparin-Induced Thrombocytopenia

Webb¹,

Warhoover²,

Eagle³

et al. 2008

J Extra Corpor Technol

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Heparin-induced thrombocytopenia paradoxically is a transient pro-thrombotic disorder triggered by heparin exposure. If not treated appropriately, it can be life threatening because of its related thromboembolic complications. In particular, it presents a unique challenge in patients needing extracorporeal life support, because anticoagulation is essential for safe management. This case report describes the safe, efficacious use of Argatroban during short-term support of a patient with a percutaneously inserted left ventricular assist TandemHeart device.

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The Use of r-Hirudin During Cardiopulmonary Bypass in a Patient with Heparin Induced Thrombocytopenia

Cited by 3 publications

References 12 publications

Classic Pages of theJournal of ExtraCorporeal Technology

Classic Pages of theJournal of ExtraCorporeal Technology

A Novel Antidote-Controlled Anticoagulant Reduces Thrombin Generation and Inflammation and Improves Cardiac Function in Cardiopulmonary Bypass Surgery

Argatroban in Short-Term Percutaneous Ventricular Assist Subsequent to Heparin-Induced Thrombocytopenia

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