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Perioperative care in an adolescent patient with heparin-induced thrombocytopenia for placement of a cardiac assist device and heart transplantation: case report and literature review

Authors Kamata M, Sebastian R, McConnell PI, Gomez D, Naguib A, Tobias JD

Received 27 July 2016

Accepted for publication 5 November 2016

Published 14 February 2017 Volume 2017:10 Pages 55—63


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Ronald Prineas

Mineto Kamata,1 Roby Sebastian,1,2 Patrick I McConnell,3 Daniel Gomez,4 Aymen Naguib,1,2 Joseph D Tobias1,2,5

1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 2Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, 3Department of Cardiothoracic Surgery, Nationwide Children’s Hospital, 4Cardiovascular Perfusion Services and Heart Center, Nationwide Children’s Hospital and The Ohio State University, 5Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

Heparin-induced thrombocytopenia (HIT) can cause life-threatening complications following the administration of heparin. Discontinuation of all sources of heparin exposure and the use of alternative agents for anticoagulation are necessary when HIT is suspected or diagnosed. We present the successful use of bivalirudin anticoagulation in an adolescent patient during cardiopulmonary bypass who underwent both placement of a left ventricular assist device and subsequent heart transplantation within a 36-hour period. The pathophysiology and diagnosis of HIT are reviewed, previous reports of the use of direct thrombin inhibitors for cardiac surgery are presented, and potential dosing regimens for bivalirudin are discussed.

Keywords: bivalirudin, anticoagulation, cardiopulmonary bypass, heart transplant

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