A pediatric patient requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation developed heparin-induced thrombocytopenia. Unfractionated heparin was discontinued, and a bivalirudin infusion was started. During the lung transplant evaluation, he was found to have allosensitization, requiring treatment with plasma exchange along with pulse methylprednisolone, rituximab, bortezomib, and pooled immunoglobulin infusion. We describe our experience with successful plasma exchange for allosensitization during bivalirudin anticoagulation on VV ECMO in a pediatric patient.
WarkentinTEGreinacherA. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 suppl):311S–337S.
2.
MartelNLeeJWellsPS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005;106(8):2710–2715.
3.
AssmannABoekenUFeindtPSchurrPAkhyariPLichtenbergA. Heparin-induced thrombocytopenia type II after cardiac surgery: predictors and outcome. Thorac Cardiovasc Surg. 2010;58(8):463–467.
4.
PieriMAgrachevaNBonaveglioEBivalirudin versus heparin as an anticoagulant during extracorporeal membrane oxygenation: a case-control study. J Cardiothorac Vasc Anesth. 2013;27(1):30–34.
5.
NagleELDagerWEDubyJJBivalirudin in pediatric patients maintained on extracorporeal life support. Pediatr Crit Care Med. 2013;14(4):e182–e188.
6.
KosterAWengYBöttcherWGromannTKuppeHHetzerR. Successful use of bivalirudin as anticoagulant for ECMO in a patient with acute HIT. Ann Thorac Surg. 2007;83(5):1865–1867.
7.
PappalardoFMajGScandroglioASampietroFZangrilloAKosterA. Bioline heparin-coated ECMO with bivalirudin anticoagulation in a patient with acute heparin-induced thrombocytopenia: the immune reaction appeared to continue unabated. Perfusion. 2009;24(2):135–137.
8.
PollakUYacobobichJTamaryHDaganOManor-ShulmanO. Heparin-induced thrombocytopenia and extracorporeal membrane oxygenation: a case report and review of the literature. J Extra Corpor Technol. 2011;43(1):5–12.
9.
RanucciMBallottaAKandilHBivalirudin-based versus conventional heparin anticoagulation for postcardiotomy extracorporeal membrane oxygenation. Crit Care. 2011;15(6):R275.
10.
JyotiAMaheshwariADanielEMotiharABhathiwalRSSharmaD. Bivalirudin in venovenous extracorporeal membrane oxygenation. J Extra Corpor Technol. 2014;46(1):94–97.
11.
HassanAEMemonMZGeorgiadisALVazquezGSuriMFQureshiAI. Safety and tolerability of high-intensity anticoagulation with bivalirudin during neuroendovascular procedures. Neurocrit Care. 2011;15(1):96–100.
12.
BatesSMWeitzJI. The mechanism of action of thrombin inhibitors. J Invasive Cardiol. 2000;12(suppl F):27F–32F.
13.
RobsonRWhiteHAylwardPFramptonC. Bivalirudinpharmacokinetics and pharmacodynamics: effect of renal function, dose, and gender. Clin Pharmacol Ther. 2002;71(6):433–439.
14.
TsuLVDagerWE. Bivalirudindosing adjustments for reduced renal function with or without hemodialysis in the management of heparin-induced thrombocytopenia. Ann Pharmacother. 2011;45(10):1185–1192.
15.
KosterAChewDGründelMAn assessment of different filter systems for extracorporeal elimination of bivalirudin: an in vitro study. Anesth Analg. 2003;96(5):1316–1319.
16.
KiserTHMacLarenRFishDNHassellKLTeitelbaumI. Bivalirudin versus unfractionated heparin for prevention of hemofilter occlusion during continuous renal replacement therapy. Pharmacotherapy. 2010;30(11):1117–1126.
17.
MannMJTsengERatcliffeMUse of bivalirudin, a direct thrombin inhibitor, and its reversal with modified ultrafiltration during heart transplantation in a patient with heparin-induced thrombocytopenia. J Heart Lung Transplant. 2005;24(2):222–225.
