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Ann Thorac Surg 2007;83:1865-1867
© 2007 The Society of Thoracic Surgeons

Case Reports

Successful Use of Bivalirudin as Anticoagulant for ECMO in a Patient With Acute HIT

Andreas Koster, MDa,*, Yuguo Weng, MDb, Wolfgang Böttcher, ECPc, Tom Gromann, MDb, Hermann Kuppe, MDa, Roland Hetzer, MDb

a Department of Anesthesia, Deutsches Herzzentrum Berlin, Berlin, Germany
b Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
c Department of Perfusion, Deutsches Herzzentrum Berlin, Berlin, Germany

Accepted for publication November 16, 2006.

* Address correspondence to Dr Koster, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin, 13305 Germany (Email: koster{at}dhzb.de).

A patient with myocardial failure after repair of an acute type A aortic dissection had acute heparin-induced thrombocytopenia develop during extracorporeal membrane oxygenation. Heparin was discontinued and the anticoagulant was switched to the direct thrombin inhibitor bivalirudin given with a bolus of 0.5 mg/kg followed by a continuous infusion of 0.5 mg/kg/h. Using this protocol, activated clotting time values ranged from 200 to 220 seconds. After prolonged extracorporeal membrane oxygenation support and recovery of left ventricular function, a right ventricular assist device was implanted during extracorporeal membrane oxygenation support with bivalirudin anticoagulation. For this procedure an additional bolus of 0.25 mg/kg bivalirudin was given, and the infusion rate increased to 1 mg/kg/h to achieve activated clotting time values of 300 to 350 seconds. Surgery was successfully performed with moderate intraoperative and postoperative blood loss and transfusion requirements.




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