Severe argatroban-induced coagulopathy in a patient with a history of heparin-induced thrombocytopenia.

Abstract

Heparin-induced thrombocytopenia is a serious complication of heparin therapy, and it remains a therapeutic challenge in the subset of patients requiring cardiopulmonary bypass. Alternative anticoagulation strategies include lepirudin, danaparoid, bivalirudin, and argatroban, or a combination of unfractionated heparin with a platelet antagonist. Argatroban is eliminated by a hepatic route, making it a practical option for patients with renal insufficiency. However, the lack of an effective antidote poses a significant problem. We present a patient with a history of heparin-induced thrombocytopenia with thrombosis who underwent a redo aortic valve replacement. Although the level of anticoagulation achieved with argatroban was initially adequate, its persistence after the completion of cardiopulmonary bypass proved to be life threatening.

• Authors: Hrvoje Gasparovic, Nadia S Nathan, Daniel Fitzgerald, Sary F Aranki
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 78 Issue 6 Pg. e89-91 (Dec 2004) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 15560992 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticoagulants
• Pipecolic Acids
• Sulfonamides
• Heparin
• Arginine
• argatroban

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (adverse effects)
• Aortic Valve (surgery)
• Aortic Valve Stenosis (surgery)
• Arginine (analogs & derivatives)
• Blood Coagulation Disorders (chemically induced)
• Heart Valve Prosthesis Implantation
• Heparin (adverse effects)
• Humans
• Male
• Pipecolic Acids (adverse effects)
• Sulfonamides
• Thrombocytopenia (chemically induced)
• Thrombosis (chemically induced)