Open AccessAnticoagulation strategies in heparin‐induced thrombocytopenia associated with renal replacement therapy
Author(s) -
Hart Robert,
Campbell Johan,
Dalchow Stephan
Publication year - 2014
Publication title -
anaesthesia cases
Language(s) - English
Resource type - Journals
ISSN - 2396-8397
DOI - 10.21466/ac.asihtaw.2014
Subject(s) - medicine , bivalirudin , heparin induced thrombocytopenia , heparin , intensive care unit , renal replacement therapy , percutaneous coronary intervention , hemofiltration , direct thrombin inhibitor , respiratory failure , intensive care medicine , surgery , warfarin , cardiology , hemodialysis , dabigatran , myocardial infarction , atrial fibrillation
Summary A 39‐yr‐old male was admitted to the intensive care unit (ICU) following thoracic and abdominal crush injuries. He subsequently developed multiple organ failure requiring respiratory, cardiovascular and renal support. Eight days after admission he was diagnosed with heparin‐induced thrombocytopenia (HIT). Anticoagulation to maintain continuous veno‐venous haemofiltration (CVVH) proved difficult using standard therapies due to both bleeding and thrombotic complications. Anticoagulation was achieved using bivalirudin, a direct thrombin inhibitor, which is not currently licensed to treat HIT unless associated with cardiac surgery or percutaneous coronary intervention. In this case report, we discuss the successful use of bivalirudin as an alternative means of anticoagulation in a patient with HIT receiving CVVH.