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Ann Thorac Surg 2004;77:711-713
© 2004 The Society of Thoracic Surgeons

Case report

Failure of argatroban anticoagulation during off-pump coronary artery bypass surgery

Mark A. Cannon, MDa*, John Butterworth, MDa, Robert D. Riley, MDa, Jacqueline M. Hyland, MD

a Departments of Anesthesiology and Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

Accepted for publication April 11, 2003.

* Address reprint requests to Dr Cannon, Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA
e-mail: marcann{at}wfubmc.edu

Heparin-induced antibodies create vexing problems during cardiac surgery. Although alternative medications have been used for intraoperative anticoagulation, the results have been sufficiently variable that no one medication is recommended. In our case, due to the poor reversibility of the antithrombin agents, argatroban was chosen as a heparin substitute due to its short half-life and its anticoagulation assessment using the activated clotting time (ACT). Unfortunately, our experience was that argatroban does not provide adequate anticoagulation during off-pump coronary bypass surgery, even when the ACT is maintained at more than 380 sec.




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