We report the successful use of r-hirudin (lepirudin) for cardiopulmonary bypass in a 67-year-old man who developed heparin-induced thrombocytopenia type II during heparin treatment of an extensive deep venous thrombosis. Lepirudin was monitored by the modified ecarin clotting time in a “mobile laboratory” set up next to the cardiac theatre, aiming for lepirudin levels of 3.5 to 4.5 μg/ml during bypass.
KadilalV.V., MayoD.J., HorneM.K.Heparin-induced thrombo-cytopenia (HIT) due to heparin flushes: a report of three cases.J Int Med1999; 246: 325–329.
4.
NandS., WongW., YuenB., YetterA., SchmulbachE., Gross FisherS.Heparin-induced thrombocytopenia with thrombosis: incidence, analysis of risk factors, and clinical outcomes in 108 consecutive patients treated at a single institution.Am J Hematol1997; 56: 12–16.
5.
LasterJ.L., NicholsW.K., SilverD.Thrombocytopenia associated with heparin-coated catheters in patients with heparin-associated antiplatelet antibodies.Arch Intern Med1989; 149: 2285–2287.
6.
RhodesG.R., DixonR.H., SilverD.Heparin-induced thrombo-cytopenia with thrombotic and haemorrhagic manifestations.Surg Gynecol Obstet1973; 136: 409–416.
7.
BacsiS., De PalmaR., VisentinG.P., GorskiJ., AsterR.H.Complexes of heparin and platelet factor 4 specifically stimulate T cells from patients with heparin-induced thrombocytopenia/ thrombosis.Blood1999; 94: 208–215.
8.
NewmanP.M., ChongB.H.Heparin-induced thrombocytopenia: new evidence for the dynamic binding of purified anti-PF4-heparin antibodies and the resultant platelet activation.Blood2000; 96: 182–187.
9.
AouifiA., BlancP., PiriouV.Cardiac surgery with cardio-pulmonary bypass in patients with type II heparin induced thrombocytopenia.Ann Thorac Surg2001, 71: 678–683.
10.
KosterA., HansenR., KuppeH., HetzerR., CrystalG.J., MertzlufftF.Recombinant hirudin as an alternative for anti-coagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II: a 1-year experience in 57 patients.J Cardiothorac Vasc Anesth2000; 14: 3, 243–248.
11.
GreinacherA.Recombinant Hirudin for the Treatment of Heparin-Induced Thrombocytopenia. In: WarkentinT.E., GreinacherA. eds. Heparin-Induced Thrombocytopenia, 2nd edition.Marcel Dekker, Inc.New York–Basle, 2001; 349–380.
12.
PoetzschB., HundS., MadlenerK., UnkrigC., Muller-BerghausG.: Monitoring of recombinant hirudin: Assessment of a plasma-based ecarin clotting time assay.Thromb Research1997B; 86: 373–383.
13.
PoetzschB., MadlenerK., SeeligC., ReissC.F., GreinacherA., Muller-BerghausG.Monitoring of r-hirudin anticoagulation during cardiopulmonary bypass—assessment of the whole blood ecarin clotting time.Thromb Haemost1997; 77: 920–925.
14.
KosterA., LoebeM., HansenR.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 ACTII device.J Thorac Cardiovasc Surg2000; 119: 1278–1283.
