Use of argatroban in combination with nafamostat mesilate in open-heart surgery for a pediatric patient with heparin-induced thrombocytopenia type II: a case report

• Published in: JA clinical reports Vol. 6; no. 1; pp. 3 - 4
• Main Authors: Kawamoto, Shuji, Kusudo, Eriko, Fukuda, Kazuhiko
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 13.01.2020; Springer Nature B.V; SpringerOpen
• Subjects: Activated coagulation time (ACT); Anesthesiology; Anticoagulants; Argatroban; Case Report; Case reports; Celite; Critical Care Medicine; Drug dosages; Emergency Medicine; Heart surgery; Heparin-induced thrombocytopenia type II (HIT II); Intensive; Kaolin; Medicine; Medicine & Public Health; Nafamostat mesilate; Ostomy; Pain Medicine; Patients; Pediatrics; Thromboembolism; Weaning; Argatroban; Activated coagulation time (ACT); Heparin-induced thrombocytopenia type II (HIT II); Celite; Kaolin; Nafamostat mesilate
• ISSN: 2363-9024; 2363-9024
• DOI: 10.1186/s40981-020-0310-6

Background Heparin-induced thrombocytopenia type II (HIT II) is a rare, immune-mediated complication of heparin therapy and can cause life-threatening thromboembolism. However, perioperative anticoagulation therapy for patients with a complication of HIT II has not been established. Case presentation A 6-year-old boy with tetralogy of Fallot underwent radical intracardiac repair with administration of argatroban at 1 year old due to positive HIT antibody. Reoperation was scheduled for pulmonary valve insufficiency, using argatroban and nafamostat mesilate as anticoagulants. Argatroban has a long onset time and the activated coagulation time (ACT) requires 7–26 h to return to the preadministration level, making hemorrhage control difficult, while half-life of nafamostat mesilate is shorter than that of argatroban. Celite ACT reflects the effects of both argatroban and nafamostat mesilate, but kaolin ACT reflects only the effect of argatroban. Due to the early termination of argatroban administration based on Celite and kaolin ACTs, ACT recovered to ≤ 200 s at 5 h after the end of argatroban administration. Conclusion Celite and kaolin ACTs can be used as markers to obtain close control of the required dose of argatroban in combination with nafamostat mesilate for the management of HIT II patients.