Patients with heparin-induced thrombocytopenia urgently requiring surgery with cardiopulmonary bypass (CPB) present a unique management challenge that must be addressed by the use of alternative anticoagulants. Although clinical success with the direct thrombin inhibitor hirudin has been reported, there is sparse information in the literature supporting the efficacy of this drug as an anti-thrombotic to prevent fibrin formation during CPB. In this report, we describe the efficacy of this drug to prevent thrombin-mediated fibrin formation during CPB.
Get full access to this article
View all access options for this article.
References
1.
Rubens FD , Lavalee G , Ruel MA , Mesana T , Bourke M . Delayed thrombin generation with hirudin anticoagulation during prolonged cardiopulmonary bypass . Ann Thorac Surg2005; 79: 334–336 .
2.
Koster A , Kuppe H , Hetzer R , Sodian R , Crystal GJ , Mertzlufft F . Emergent cardiopulmonary bypass in five patients with heparin-induced thrombocytopenia type II employing recombinant hirudin . Anesthesiology1998; 89: 777–780 .
3.
Kappa JR , Fisher CA , Todd B et al. Intraoperative management of patients with heparin-induced thrombocytopenia . Ann Thorac Surg1990; 49: 714–722 .
4.
Koster A , Loebe M , Hansen R et al. A quick assay for monitoring recombinant hirudin during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II: adaptation of the ecarin clotting time to the ACT II device . J Thorac Cardiovasc Surg2000; 199: 1278–1283 .
5.
Rao AK , Sun L , Chesebro JH et al. Distinct effects of recombinant desulfatohirudin (Revasc) and heparin on plasma levels of fibrinopeptide A and prothrombin fragment F1.2 in unstable angina. A multicenter trial . Circulation1996; 94: 2389–2395 .
6.
Edmunds HL , Hessel EA , Colman RW , Menasche P . Extracorporeal circulation. In Edmunds HL , Cohn LH eds. Cardiac surgery in the adult. McGraw-Hill Professional , 2003: 315–387.
7.
Weitz JI , Hudoba M , Massel D , Maraganore J , Hirsh J . Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III-independent inhibitors . J Clin Invest1990; 86: 385–391 .
8.
Markwardt F.Hirudin and derivatives as anticoagulant agents . Thromb Hemostas1991; 66: 141–152 .
9.
Fenton JW , Villanueva GB , Ofosu FA , Maraganore JM . Thrombin inhibition by hirudin: how hirudin inhibits thrombin . Haemostasis1991; 21: 27–31 .
10.
Zoldhelyi P , Bichler J , Owen WG et al. Coronary heart disease/myocardial infarction: persistent thrombin generation in humans during specific thrombin inhibition with hirudin . Circulation1994; 90: 2671–2678 .
11.
Stone SR , Hofsteenge J . Kinetics of the inhibition of thrombin by hirudin . Biochem J1986; 25: 4622–4628 .
