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Preemptive use of bivalirudin for urgent on-pump coronary artery bypass grafting in patients with potential heparin-induced thrombocytopenia.

Publication ,  Journal Article
Dyke, CM; Koster, A; Veale, JJ; Maier, GW; McNiff, T; Levy, JH
Published in: Ann Thorac Surg
July 2005

PURPOSE: The use of heparin in patients with heparin-induced thrombocytopenia (HIT) may result in severe complications or death. The diagnosis of HIT is frequently uncertain, however. Alternative anticoagulants in at-risk patients undergoing cardiac surgery with cardiopulmonary bypass remain problematic. The novel short-acting, direct-thrombin inhibitor bivalirudin is the only alternative to heparin/protamine being used in elective non-HIT patients during CPB. DESCRIPTION: Four patients with severe thrombocytopenia after heparin exposure and suspected acute HIT underwent on-pump coronary artery bypass grafting surgery with preemptive use of bivalirudin. A continuous bivalirudin infusion was used during cardiopulmonary bypass, and activated clotting times were used to monitor anticoagulation. EVALUATION: Anticoagulation with bivalirudin during cardiopulmonary bypass was effective and uncomplicated. Duration of operation was not prolonged, and perioperative blood loss and transfusion rates were acceptable. Activated clotting times were helpful for monitoring anticoagulation in these patients. CONCLUSIONS: These data provide further evidence of the feasibility of bivalirudin for anticoagulation during on-pump coronary artery bypass graft surgery in urgent clinical situations.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

July 2005

Volume

80

Issue

1

Start / End Page

299 / 303

Location

Netherlands

Related Subject Headings

  • Thrombocytopenia
  • Respiratory System
  • Recombinant Proteins
  • Peptide Fragments
  • Middle Aged
  • Male
  • Humans
  • Hirudins
  • Heparin
  • Female
 

Citation

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Dyke, C. M., Koster, A., Veale, J. J., Maier, G. W., McNiff, T., & Levy, J. H. (2005). Preemptive use of bivalirudin for urgent on-pump coronary artery bypass grafting in patients with potential heparin-induced thrombocytopenia. Ann Thorac Surg, 80(1), 299–303. https://doi.org/10.1016/j.athoracsur.2004.08.037
Dyke, Cornelius M., Andreas Koster, James J. Veale, George W. Maier, Thomas McNiff, and Jerrold H. Levy. “Preemptive use of bivalirudin for urgent on-pump coronary artery bypass grafting in patients with potential heparin-induced thrombocytopenia.Ann Thorac Surg 80, no. 1 (July 2005): 299–303. https://doi.org/10.1016/j.athoracsur.2004.08.037.
Dyke CM, Koster A, Veale JJ, Maier GW, McNiff T, Levy JH. Preemptive use of bivalirudin for urgent on-pump coronary artery bypass grafting in patients with potential heparin-induced thrombocytopenia. Ann Thorac Surg. 2005 Jul;80(1):299–303.
Dyke, Cornelius M., et al. “Preemptive use of bivalirudin for urgent on-pump coronary artery bypass grafting in patients with potential heparin-induced thrombocytopenia.Ann Thorac Surg, vol. 80, no. 1, July 2005, pp. 299–303. Pubmed, doi:10.1016/j.athoracsur.2004.08.037.
Dyke CM, Koster A, Veale JJ, Maier GW, McNiff T, Levy JH. Preemptive use of bivalirudin for urgent on-pump coronary artery bypass grafting in patients with potential heparin-induced thrombocytopenia. Ann Thorac Surg. 2005 Jul;80(1):299–303.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

July 2005

Volume

80

Issue

1

Start / End Page

299 / 303

Location

Netherlands

Related Subject Headings

  • Thrombocytopenia
  • Respiratory System
  • Recombinant Proteins
  • Peptide Fragments
  • Middle Aged
  • Male
  • Humans
  • Hirudins
  • Heparin
  • Female