Premium
Massive Pulmonary Embolism due to Late‐Onset Heparin‐Induced Thrombocytopenia following Coronary Artery Bypass Graft Surgery:
Author(s) -
Badmanaban Balaji,
Sachithanandan Anand,
Hunter Ian,
Graham Alastair,
Sarsam Mazin
Publication year - 2003
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1046/j.1540-8191.2003.02036.x
Subject(s) - medicine , lepirudin , heparin induced thrombocytopenia , heparin , hirudin , pulmonary embolism , argatroban , bivalirudin , cardiopulmonary bypass , surgery , thrombosis , direct thrombin inhibitor , discovery and development of direct thrombin inhibitors , anticoagulant , adverse effect , discontinuation , thrombolysis , anesthesia , cardiology , warfarin , platelet , thrombin , myocardial infarction , percutaneous coronary intervention , atrial fibrillation , dabigatran
Most cardiac surgical patients have had previous exposure to heparin for diagnostic or therapeutic interventions and hence have an increased susceptibility to developing heparin‐induced thrombocytopenia (HIT) postoperatively. HIT is an immune‐mediated adverse drug reaction that may be associated with limb or life‐threatening thrombosis. Heparin cessation is a vital first step in treatment; however, alternative anticoagulant therapy is essential. Recombinant hirudin (lepirudin), a thrombin‐specific inhibitor, provides safe and effective anticoagulation in such patients. We describe a case of delayed onset HIT with resulting massive pulmonary embolism postcardiac surgery that was successfully managed with lepirudin. (J Card Surg 2003; 18:316‐318)