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Ann Thorac Surg 2000;69:37-41
© 2000 The Society of Thoracic Surgeons
a Deutsches Herzzentrum Berlin, Berlin, Germany
Address reprint requests to Dr Pasic, Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Augustenburger Platz 1, D-13353 Berlin, Germany
e-mail: pasic{at}dhzb.de
Presented at the Poster Session of the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.
Background. Recombinant hirudin is an alternative anticoagulant for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II. Although there is no neutralizing agent for recombinant hirudin, its fast renal elimination enables quick cessation of bleeding after cardiopulmonary bypass. The aim of the study was to compare anticoagulant effects of recombinant hirudin in regards to renal function in patients with heparin-induced thrombocytopenia type II.
Methods. Twenty-one patients (mean age, 65 years, and range, 35 to 82 years) underwent different complex cardiovascular procedures using recombinant hirudin as the anticoagulant for cardiopulmonary bypass. Postoperative blood loss, transfusion requirements, and hemostatic variables were compared between patients with a creatinine level lower than 1.5 mg/dL (group 1, normal renal function; n = 17 patients) and those with a creatinine level greater than 1.5 mg/dL (group 2, impaired renal function; n = 4 patients).
Results. The patients in group I showed no increased tendency toward postoperative bleeding. In contrast, all 4 patients in group 2 required reexploration for increased postoperative bleeding. They had higher activated partial thromboplastin times and transfusion requirements postoperatively.
Conclusions. If recombinant hirudin is used as the anticoagulant for cardiopulmonary bypass in patients with heparin-induced thrombocytopenia type II and impaired renal function, the risk of postoperative bleeding is increased.
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