Successful Use of Bivalirudin for Combined Carotid Endarterectomy and Coronary Revascularization with the Use of Cardiopulmonary Bypass in a Patient with an Elevated Heparin-Platelet Factor 4 Antibody Titer

• Published in: Anesthesia and analgesia Vol. 108; no. 4; pp. 1113 - 1115
• Main Authors: AVERY, Edwin G, HILGENBERG, Alan D, CAMBRIA, Richard P, BECKERLY, Rena, DONNELLY, Anne M, LAPOSATA, Michael
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.04.2009
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Autoantibodies - blood; Biological and medical sciences; Blood Coagulation - drug effects; Cardiopulmonary Bypass; Carotid Stenosis - blood; Carotid Stenosis - complications; Carotid Stenosis - immunology; Carotid Stenosis - surgery; Coronary Artery Bypass; Coronary Artery Disease - blood; Coronary Artery Disease - complications; Coronary Artery Disease - immunology; Coronary Artery Disease - surgery; Endarterectomy, Carotid; Heparin - adverse effects; Hirudins; Humans; Intraoperative Care; Male; Medical sciences; Middle Aged; Peptide Fragments - therapeutic use; Platelet Factor 4 - immunology; Recombinant Proteins - therapeutic use; Thrombocytopenia - chemically induced; Thrombocytopenia - immunology; Treatment Outcome; Human; Peptides; Serine endopeptidases; Enzyme; Enzyme inhibitor; Cardiovascular disease; Thrombin; Anticoagulant; Bivalirudin; Antithrombin; Coronary heart disease; Cardiopulmonary bypass; Peptidases; Platelet; Polypeptide; Carotid; Glycosaminoglycan; Hydrolases; Anesthesia; Heparin
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ane.0b013e318196cd51

We report a combined carotid endarterectomy and coronary revascularization surgery with cardiopulmonary bypass using bivalirudin for systemic anticoagulation in a patient with a positive titer for the heparin-platelet factor 4 antibody. The patient experienced procedural success for both the carotid and coronary surgeries. Increased blood and blood product transfusion was required postoperatively.