• Brent A Anderegg, G Mark Baillie, Walter E Uber, Kenneth D Chavin, Angello Lin, Prabhakar K Baliga, and John Lazarchick.
• Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
• Ann. Clin. Lab. Sci. 2008 Jan 1; 38 (3): 277-82.

AbstractType II heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome that may arise in a time-dependent manner following heparin therapy, placing patients at significant risk for thromboembolic events. Therapy includes anticoagulation with a direct thrombin inhibitor and avoidance of heparin. We report a patient with Budd-Chiari syndrome and a history of heparin-induced thrombocytopenia who presented for orthotopic liver transplant and required postoperative anticoagulation with bivalirudin. During the post-transplant graft function improvement, we observed a significant dose-effect alteration manifested by an increased bivalirudin dose requirement as factor V activity increased. This observation is an important consideration in the attempt to maintain an optimal balance between effective anticoagulation and a reduced risk of postoperative bleeding.

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