• J Card Surg · Jan 2007

    Case Reports

    Deep hypothermic circulatory arrest and bivalirudin use in a patient with heparin-induced thrombocytopenia and antiphospholipid syndrome.

    • Kay B Leissner, Ara Ketchedjian, Richard Crowley, Rafael Ortega, Jan F Hesselvik, and Richard J Shemin.
    • Department of Anesthesiology, Boston University Medical Center, Boston University, Boston, Massachusetts 02118, USA. kbleissner@yahoo.com
    • J Card Surg. 2007 Jan 1; 22 (1): 78-82.

    BackgroundPatients with heparin-induced thrombocytopenia II (HIT II) need an alternative nonheparin-based method of anticoagulation for cardiopulmonary bypass (CPB) to prevent thrombosis and thrombosis related complications.MethodsBivalirudin was used during CPB and deep hypothermic circulatory arrest (DHCA) for resection of multiple right atrial masses in a patient with HIT II and antiphospholipid antibodies syndrome (APS). Anticoagulation was monitored with the activated clotting time (ACT) and a target ACT of 450 seconds or greater was maintained.ResultsSurgical removal of multiple right atrial masses was successful and there was no evidence of thromboembolic events. Clot was noticed in the cardiotomy and venous reservoir after CPB was discontinued and the system flushed. The postoperative course was uneventful.ConclusionsAnticoagulation was successfully managed with bivalirudin, a new short-acting, and direct thrombin inhibitor. Further studies are necessary to evaluate the safety of bivalirudin during DHCA.

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