Bleeding after intermittent or continuous r-hirudin during CVVH.

Abstract

OBJECTIVE:

To demonstrate bleeding complications encountered in patients after cardiac surgery on continuous venovenous haemofiltration (CVVH) treated with continuous versus intermittent r-hirudin for heparin-induced thrombocytopenia (HIT) type II.

DESIGN:

Case description.

SETTING:

Cardiothoracic intensive care unit at a university hospital.

PATIENTS:

5 consecutive patients with proven HIT type II on CVVH after major cardiac surgery.

INTERVENTIONS:

Recombinant hirudin (r-hirudin) was given continuously at a dose of 0.01 mg/kg per h in three patients or in repeated bolus administration of 0.05 mg/kg in two patients.

MEASUREMENTS AND RESULTS:

Since the ecarin clotting time assay was not available at that time to monitor hirudin effects on coagulation, the activated partial thromboplastin time (normal range 26-38 s, target range 50-60 s) was used. The continuously treated patients suffered from major bleeding complications. Therefore, the regimen was changed to repeated bolus administration, reducing the incidence of bleeding complications probably due to a threefold diminished cumulative hirudin dose per day in comparison to continuous administration.

CONCLUSIONS:

If ecarin clotting time, the most suitable monitor for hirudin activation, is not available, we would prefer to give r-hirudin in repeated boluses to avoid major bleeding complications in cardiac surgery patients on CVVH.

• Authors: H Kern, S Ziemer, W J Kox
• Journal: Intensive care medicine (Intensive Care Med) Vol. 25 Issue 11 Pg. 1311-4 (Nov 1999) ISSN: 0342-4642 [Print] United States
• PMID: 10654220 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticoagulants
• Antithrombins
• Hirudins
• Heparin

Topics

• Aged
• Anticoagulants (adverse effects)
• Antithrombins (administration & dosage, adverse effects)
• Aortic Valve (surgery)
• Cardiac Surgical Procedures
• Coronary Artery Bypass
• Fatal Outcome
• Heart Valve Prosthesis Implantation
• Hemofiltration
• Heparin (adverse effects)
• Hirudins (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Postoperative Hemorrhage (chemically induced)
• Reoperation
• Thrombocytopenia (chemically induced, drug therapy)