Non-recovery of ACT in a patient with heparin-induced thrombocytopenia type II during mitral valve replacement using argatroban anticoagulation

• Published in: Journal of anesthesia Vol. 27; no. 6; pp. 951 - 955
• Main Authors: Tanigawa, Yoshinori, Yamada, Tomoko, Matsumoto, Koichi, Nakagawachi, Akira, Torikai, Arisu, Sakaguchi, Yoshirou
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.12.2013
• Subjects: Aged; Anesthesiology; Anticoagulants - therapeutic use; Blood Coagulation - drug effects; Cardiopulmonary Bypass - methods; Clinical Report; Critical Care Medicine; Emergency Medicine; Female; Heart Valve Prosthesis Implantation - methods; Heparin - adverse effects; Humans; Intensive; Medicine; Medicine & Public Health; Mitral Valve - surgery; Pain Medicine; Pipecolic Acids - therapeutic use; Thrombocytopenia - chemically induced; Thrombocytopenia - drug therapy; Thrombocytopenia - surgery; Thrombocytopenia - therapy; Whole Blood Coagulation Time - methods; CPB; Argatroban; Heparin-induced thrombocytopenia type II
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-013-1629-1

Argatroban was used as the anticoagulant during cardiopulmonary bypass (CPB) in a patient with heparin-induced thrombocytopenia (HIT) type II undergoing mitral valve replacement. Dosage was reduced because of preoperative congestive liver disorder. Perioperative coagulability was poor, and, ultimately, failure of hemostasis led to a fatal outcome. Although argatroban use as an anticoagulant for HIT is reported, the optimal dose has not been established. During long-term CPB, increasing the total dosage may extend anticoagulant ability, leading to dose dependence. Because no antagonist for argatroban exists, failure of hemostasis might occur.