Lepirudin for Cardiopulmonary Bypass Surgery in a Patient with Terminal Renal Insufficiency and Acute Heparin-Induced Thrombocytopenia

Abstract

A patient with triple heart valve disease, heparin-induced thrombocytopenia, and terminal renal insufficiency was treated successfully using lepirudin for anticoagulation of cardiopulmonary bypass (CPB) and during the postoperative course. Anticoagulatory monitoring was performed with ecarin clotting time during CPB and aPTT postoperatively.

Key words

Hirudin - cardiopulmonary - bypass - renal failure - heparin-induced thrombocytopenia - hemofiltration

References

• 1 Riess F C, Poetzsch B, Mueller-Berghaus G. Recombinant hirudin as an anticoagulant during cardiac surgery. Pifarré R New Anticoagulants for the Cardiovascular Patient. Philadelphia; Hanley & Belfu 1997: 197-221
• 2 Pötzsch B, Madlener K, Seelig C, Riess C F, Greinacher A, Müller-Berghaus G. Monitoring of r-hirudin anticoagulation during cardiopulmonary bypass - assessment of the whole blood ecarin clotting time.  Thromb Haemost. 1997;  77 920-925
• 3 Slaughter T F, Sreeram G, Sharma A D, El-Moalem H, East C J, Greenberg C S. Reversible shear-mediated platelet dysfunction during cardiac surgery as assessed by the PFA‐100 platelet function analyzer.  Blood Coagul Fibrinolysis. 2001;  12 85-93
• 4 Koster A, Pasic M, Bauer M, Kuppe H, Hetzer R. Hirudin as anticoagulant for cardiopulmonary bypass: importance of preoperative renal function.  Ann Thorac Surg. 2000;  69 37-41
• 5 Vanholder R, Camez A, Veys N, Van Loo A, Dhondt A M, Ringoir S. Pharmacokinetics of recombinant hirudin in hemodialyzed end-stage renal failure patients.  Thromb Haemost. 1997;  77 650-655
• 6 Koza M J, Walenga J M, Fareed J, Pifarre R. A new approach in monitoring recombinant hirudin during cardiopulmonary bypass.  Semin Thromb Hemost. 1993;  19 90-96
• 7 Eichler P, Friesen H J, Lubenow N, Jaeger B, Greinacher A. Antihirudin antibodies in patients with heparin-induced thrombocytopenia treated with lepirudin: incidence, effects on aPTT, and clinical relevance.  Blood. 2000;  96 2373-2378