Extracorporeal membrane oxygenation bridging to lung transplant complicated by heparin-induced thrombocytopenia

• Published in: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation Vol. 8; no. 4; p. 329
• Main Authors: Dolch, Michael E, Frey, Lorenz, Hatz, Rudolf, Uberfuhr, Peter A, Beiras-Fernandez, Andres, Behr, Jurgen, Irlbeck, Michael, Lung Transplant Group, The Munich
• Format: Journal Article
• Language: English
• Published: Turkey 01-12-2010
• Subjects: Adult; Anticoagulants - adverse effects; Extracorporeal Membrane Oxygenation - adverse effects; Fatal Outcome; Heparin - adverse effects; Humans; Lung Transplantation - adverse effects; Male; Multiple Organ Failure - etiology; Pipecolic Acids - therapeutic use; Respiration, Artificial; Respiratory Distress Syndrome, Adult - blood; Respiratory Distress Syndrome, Adult - drug therapy; Respiratory Distress Syndrome, Adult - surgery; Respiratory Distress Syndrome, Adult - therapy; Respiratory Insufficiency - blood; Respiratory Insufficiency - drug therapy; Respiratory Insufficiency - surgery; Respiratory Insufficiency - therapy; Thrombocytopenia - chemically induced; Time Factors; Treatment Outcome
• ISSN: 2146-8427

In patients with acute respiratory failure and life-threatening impairment of pulmonary gas exchange, venovenous extracorporeal membrane oxygenation offers further therapeutic options. During extracorporeal membrane oxygenation treatment, systemic anticoagulation is usually achieved by heparin administration, which exposes patients to the risk of heparin-induced thrombocytopenia type II. We present a patient with acute respiratory distress syndrome on venovenous extracorporeal membrane oxygenation who experienced heparin-induced thrombocytopenia type II and in whom anticoagulation was continued with argatroban. Because respiratory failure did not resolve, the patient was bridged to lung transplant with extracorporeal membrane oxygenation. Argatroban anticoagulation was safely used until lung transplant (on day 114 after extracorporeal membrane oxygenation initiation) and after transplant in the presence of hepatic failure.