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Ann Thorac Surg 2006;81:2308-2310
© 2006 The Society of Thoracic Surgeons

Case report

Bivalirudin Anticoagulation for a Patient with Hypercoagulable Immune Syndromes Undergoing Mitral Valve Surgery

Rebecca L. Cain, MD a , * , Bruce D. Spiess, MD a , Mark Nelson, MD a , Abe Deanda, Jr, MD b , Harry L. McCarthy, CCP b , Jeffrey A. Green, MD a

a Department of Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
b Division of Cardiothoracic Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia

Accepted for publication August 22, 2005.

* Address correspondence to Dr Cain, Virginia Commonwealth University Medical Center, Department of Anesthesiology, 1200 E Broad St, Box 980695, Richmond, VA 23298-0695 (Email: rebeccs13{at}aol.com).

Unfractionated heparin has been a near universal anticoagulant for cardiac surgery; however it is contraindicated in heparin-induced thrombocytopenia type II. Alternative anticoagulants such as bivalirudin (a direct thrombin inhibitor) are being utilized. Bivalirudin was successfully used in an immunologically complex patient (diagnoses of heparin-induced thrombocytopenia type II, systemic lupus erythematosus, antiphospholipid syndrome, and dialysis-dependent renal failure) requiring cardiopulmonary bypass. Thrombotic events are common in antiphospholipid syndrome patients undergoing cardiac surgery utilizing high-dose heparin. This may represent unrecognized heparin-induced thrombocytopenia type II. Our patient did not experience perioperative thrombotic or bleeding complications. The possible cross-reactivity between heparin induced thrombocytopenia type II and antiphospholipid syndrome has not been investigated.




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 The Annals of PharmacotherapyHome page
Q. A Czosnowski, S. W Finks, and K. C Rogers
Bivalirudin for Patients with Heparin-Induced Thrombocytopenia Undergoing Cardiovascular Surgery
Ann. Pharmacother., September 1, 2008; 42(9): 1304 - 1309.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
H. Gorki, V. Malinovski, and R. D.L. Stanbridge
The antiphospholipid syndrome and heart valve surgery
Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 168 - 181.
[Abstract] [Full Text] [PDF]


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