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PEDIATRIC ANESTHESIA

Bidirectional Glenn Shunt Surgery Using Lepirudin Anticoagulation in an Infant with Heparin-Induced Thrombocytopenia with Thrombosis

Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY USA

Address correspondence to Ellen D. Iannoli, M.D., 601 Elmwood Avenue Box 604, Rochester, NY 14642. Address e-mail to Ellen_iannoli{at}urmc.rochester.edu.

There are few reports of the management of pediatric patients with heparin-induced thrombocytopenia (HIT) requiring cardiac surgery using currently available anticoagulants. We report a case of an infant with HIT requiring a bidirectional Glenn shunt who was successfully managed using lepirudin (r-hirudin, Refludan; Aventis, Bridgewater, NJ). Dosing and monitoring of anticoagulation were difficult, and we suggest caution in the use of lepirudin for cardiac surgery unless reliable monitoring of the degree of anticoagulation becomes available.