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Ann Thorac Surg 2003;76:273-275
© 2003 The Society of Thoracic Surgeons

Case report

Bivalrudin use in off-pump myocardial revascularization in patients with heparin-induced thrombocytopenia

Jeffrey N. Bott, MD*a, Karan Reddy, MDb, Stacie Krick, PharmDc

a Department of Cardiovascular Surgery, Orlando, Florida, USA
b Department of Cardiology, Orlando, Florida, USA
c Department of Pharmacy, Orlando Regional Medical Center, Orlando, Florida, USA

Accepted for publication January 19, 2003.

* Address reprint requests to Dr Bott, 217 Hillcrest St, Orlando, FL 32809, USA
e-mail: jbott{at}cvsorlando.com

With advances in therapy of acute coronary syndromes, repetitive exposure to heparin has become commonplace. Consequently, the incidence of heparin-induced thrombocytopenia has risen. Limited strategies for management exist, and new thrombin inhibitors may provide safe alternatives to heparin. Two patients with documented heparin-induced thrombocytopenia underwent revascularization using a new thrombin inhibitor (Bivalrudin [Angiomax, Medicines Co, Cambridge, MA]) for anticoagulation. Both patients had uneventful perioperative hospitalizations. Thrombin inhibition with Bivalrudin (Angiomax) may provide a safe reliable alternative to heparin use in cardiac surgery.




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