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CARDIOVASCULAR ANESTHESIA

The Use of Argatroban for Carotid Endarterectomy in Heparin-Induced Thrombocytopenia

Sarah E. Hallman, MD^*, Latha Hebbar, MD, FRCA^*, Jay Robison, MD, and Walter E. Uber, PharmD

*Department of Anesthesia and Perioperative Medicine, Division of Vascular Surgery, Department of Pharmacy Services, Childrens Hospital, Medical University of South Carolina, Charleston

Address correspondence and reprint requests to Sarah E. Hallman, MD, Department of Anesthesia and Perioperative Medicine, Childrens Hospital, Medical University of South Carolina, 165 Ashley Ave., Suite 525, P.O. Box 250912, Charleston, SC 29425. Address e-mail to hallman{at}musc.edu.

Heparin-induced thrombocytopenia (HIT) is a major obstacle in cardiovascular surgeries. In this case report, we used argatroban, a direct thrombin inhibitor, to achieve and maintain anticoagulation for carotid endarterectomy. Unlike heparin, the direct thrombin inhibitors bind directly to thrombin, bypassing antithrombin III and the potential to precipitate HIT. A bolus of argatroban 150 µg/kg followed by an infusion of 5 µg · kg^–1 · min^–1 was used, and adequate anticoagulation was demonstrated with multiple laboratory tests (at 28 min, prothrombin time = 29.8 s, partial thromboplastin time = 69.1 s, international normalized ratio = 3.52 s, and activated clotting time = 220 s). The surgery was successful, and the patient was discharged the next day with no postoperative neurologic sequelae or other complications. We conclude that argatroban can be used safely and successfully for carotid endarterectomy in a patient with a history of HIT.

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