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

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Case Reports

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

^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.

This article has been cited by other articles:

				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]