Anticoagulation for patients with heparin-induced thrombocytopenia using recombinant hirudin during cardiopulmonary bypass

• Published in: Journal of clinical anesthesia Vol. 14; no. 6; pp. 452 - 455
• Main Authors: Liu, Hong, Fleming, Neal W, Moore, Peter G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2002; Elsevier Science
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Anticoagulation; Biological and medical sciences; Cardiopulmonary Bypass; Drug toxicity and drugs side effects treatment; Female; heparin; Heparin - adverse effects; hirudin; Hirudins - analogs & derivatives; Humans; Male; Medical sciences; Pharmacology. Drug treatments; recombinant; Recombinant Proteins - therapeutic use; Risk Factors; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; thrombocytopenia; Thrombocytopenia - chemically induced; Thrombocytopenia - complications; Thrombosis - etiology; Thrombosis - prevention & control; Toxicity: blood; heparin; cardiopulmonary bypass; recombinant; Anticoagulation; thrombocytopenia; hirudin; Human; Thrombocytopenia; Blood coagulation; Peptides; Toxicity; General anesthesia; Hemopathy; Anticoagulant; Antiplatelet agent; Hirudin; Cardiopulmonary bypass; Case study; Platelet; Polypeptide; Glycosaminoglycan; Heparin; Monitoring; Lepirudin
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/S0952-8180(02)00386-0

Heparin-induced thrombocytopenia (HIT) is a common complication of heparin therapy. There are three types of HIT. In the majority of patients, thrombocytopenia is modest and resolves without sequelae (HIT I). In a smaller number of patients, the thrombocytopenia is severe (HIT II), and in still others, the thrombocytopenia is also associated with thrombosis (HITT). Administration of heparin to this latter group of patients causes platelet aggregation, thromboembolism, and thrombocytopenia. It is advisable that heparin not be administered in any form to patients with documented or suspected HIT II or HITT. This situation, of course, poses a problem for those patients requiring cardiopulmonary bypass (CPB) surgery. In this report, we summarize our experience with Lepirudin (Hoechst, Frankfurt Ammain, Germany), which is a recombinant hirudin (r-hirudin), as an alternative to heparin for systemic anticoagulation, as well as the use of the ecarine clotting time (ECT) for monitoring anticoagulation status during CPB.