Anticoagulative management of patients requiring left ventricular assist device implantation and suffering from heparin-induced thrombocytopenia type II

被引:32
作者
Christiansen, S
Jahn, UR
Meyer, J
Scheld, HH
Van Aken, H
Kehrel, BE
Hammel, D
机构
[1] Univ Munster, Dept Thorac & Cardiovasc Surg, D-48149 Munster, Germany
[2] Univ Munster, Dept Anesthesiol & Operat Intens Care Med, D-48149 Munster, Germany
[3] Univ Munster, Dept Expt & Clin Hematol, D-48149 Munster, Germany
关键词
D O I
10.1016/S0003-4975(99)01423-X
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Heparin-induced thrombocytopenia type II. (HIT II) is a rare but life-threatening side effect of heparin therapy. We describe the perioperative anticoagulative management of patients tested positive for HIT II and requiring implantation of a left ventricular assist device (LVAD). Methods. We report on 3 patients with a different perioperative anticoagulative management (preoperative, intraoperative, and postoperative anticoagulation with danaparoid-sodium; preoperative anticoagulation with recombinant hirudin, anticoagulation with danaparoid-sodium intraoperatively and postoperatively; preoperative anticoagulation with recombinant hirudin, intraoperative anticoagulation with heparin, and postoperative anticoagulation with danaparoid-sodium) and discuss the difficulties of the treatment. Results. Anticoagulation with alternative drugs such as recombinant hirudin and danaparoid-sodium led to serious and life-threatening bleeding complications as well as to thromboembolic events in the first 2 patients. Therefore the third patient underwent LVAD implantation using heparin for intraoperative anticoagulation to avoid administration of high doses of recombinant hirudin or danaparoid-sodium, Despite very low anti-factor Xa activities, when using danaparoid-sodium postoperatively, the patient suffered from a bleeding complication on the 4th day after LVAD implantation requiring reexploration, Conclusions. In selected cases (negative heparin-induced platelet aggregation (HIPA) test at the time of LVAD implantation and continuation of postoperative anticoagulation with recombinant hirudin or danaparoid-sodium), heparin may be used for LVAD implantation in HIT II patients to reduce bleeding complications, (C) 2000 by The Society of Thoracic Surgeons.
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页码:774 / 777
页数:4
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