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Case Reports
Severe argatroban-induced coagulopathy in a patient with a history of heparin-induced thrombocytopenia.
- Hrvoje Gasparovic, Nadia S Nathan, Daniel Fitzgerald, and Sary F Aranki.
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
- Ann. Thorac. Surg. 2004 Dec 1;78(6):e89-91.
AbstractHeparin-induced thrombocytopenia is a serious complication of heparin therapy, and it remains a therapeutic challenge in the subset of patients requiring cardiopulmonary bypass. Alternative anticoagulation strategies include lepirudin, danaparoid, bivalirudin, and argatroban, or a combination of unfractionated heparin with a platelet antagonist. Argatroban is eliminated by a hepatic route, making it a practical option for patients with renal insufficiency. However, the lack of an effective antidote poses a significant problem. We present a patient with a history of heparin-induced thrombocytopenia with thrombosis who underwent a redo aortic valve replacement. Although the level of anticoagulation achieved with argatroban was initially adequate, its persistence after the completion of cardiopulmonary bypass proved to be life threatening.
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