The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
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J. Heart Lung Transplant. · Jun 2006
Case Reports Comparative StudyArgatroban, bivalirudin, and lepirudin do not decrease clot propagation and strength as effectively as heparin-activated antithrombin in vitro.
Heparin-induced thrombocytopenia is a potentially limb- and life-threatening response to heparin exposure. Direct thrombin inhibitors (DTIs) have been reported to provide anti-coagulation for cardiopulmonary bypass; however, clot formation within the cardiopulmonary bypass circuit has been reported after the administration of DTIs. We present a case of thrombosis of the cardiopulmonary bypass circuit and, ultimately, death after argatroban administration. An in vitro thrombelastographic assessment of the effects of DTIs on clot kinetics was consequently performed to determine potential causes for this complication. ⋯ DTIs demonstrated a significant prolongation of clot initiation but poor attenuation of propagation and strength. Further in vitro and clinical investigations to design a heparin-equivalent regimen to provide anti-coagulation for patients with heparin-induced thrombocytopenia are indicated.
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J. Heart Lung Transplant. · Jun 2006
Case ReportsMycotic pseudo-aneurysm of the ascending thoracic aorta after cardiac transplantation.
A large mycotic pseudo-aneurysm of the ascending thoracic aorta was found in a patient with empyema and infectious mediastinitis after an orthotopic heart transplant procedure. The patient underwent surgical resection of the pseudo-aneurysm with patch aortoplasty and was treated with appropriate long-term antibiotic therapy. The patient continues to do well 3 months after surgery. Early surgical intervention combined with pre-operative and prolonged post-operative antibiotic therapy and close follow-up is essential in these patients.