Successful intraprocedural anticoagulation with bivalirudin during pulmonary vein isolation in a patient with known heparin-induced thrombocytopenia type II

• Published in: Journal of arrhythmia Vol. 32; no. 2; pp. 154 - 155
• Main Authors: Bellmann, Barbara, MD, Nagel, Patrick, MD, Muntean, Bogdan G., MD
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01-04-2016; Elsevier; Wiley
• Subjects: Ablation; Activated clotting time; Angioplasty; Apixaban; Atrial fibrillation; Bivalirudin; Blood; Blood platelets; Cardiac arrhythmia; Cardiovascular; Conflicts of interest; Coronary heart disease; Health aspects; Heparin induced thrombocytopenia type II; Laboratories; Medical examination; Patients; Pulmonary vein isolation; Rapid Firing; Thrombocytopenia; Veins & arteries; Heparin induced thrombocytopenia type II; Bivalirudin; Activated clotting time; Atrial fibrillation; Pulmonary vein isolation
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1016/j.joa.2015.10.004

Abstract We report the case of a 56-year-old female who presented with symptomatic paroxysmal atrial fibrillation. Anamnestic heparin-induced thrombocytopenia (HIT) type II was suspected, and a rapid diagnostic test showed antibodies against platelet factor 4. The heparin-induced platelet activation-assay was negative. Radiofrequency pulmonary vein isolation with intraprocedural anticoagulation using bivalirudin was ultimately performed. Dosing was controlled by monitoring the activated clotting time. Post-procedural blood tests were normal. There were no thromboembolic or bleeding events. Bivalirudin is a therapeutic option for anticoagulation during pulmonary vein isolation procedures in patients with a history of HIT type II.