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Anticoagulation with Bivalirudin during Deep Hypothermic Circulatory Arrest in a Patient with Heparin-Induced Thrombocytopenia
Authors:Agamemnon Pericleous  Mostafa Sadek  Mary Fitzmaurice  Constance Caldwell  Kris Natividad  Konstadinos A Plestis
Abstract:Heparin-induced thrombocytopenia is a well-recognized complication of anticoagulation with heparin. We present the case of a patient with recent heparin-induced thrombocytopenia who subsequently needed surgery on an emergency basis for acute type A aortic dissection. This article reports the successful use of bivalirudin, a direct thrombin inhibitor, as an alternative to heparin throughout cardiopulmonary bypass and deep hypothermic circulatory arrest. We contend that bivalirudin is a safe alternative to heparin when performing surgery for aortic dissection and should be considered as an option for use in patients who present with heparin-induced thrombocytopenia.
Keywords:Anticoagulants/adverse effects  aortic dissection  bivalirudin  blood coagulation  blood loss  surgical  cardiopulmonary bypass  circulatory arrest  deep hypothermia induced  hemofiltration  heparin/adverse effects  hirudins  thrombocytopenia/chemically induced/prevention &  control
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