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CARDIOVASCULAR ANESTHESIOLOGY

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

Edwin G. Avery, MD^*, Alan D. Hilgenberg, MD, Richard P. Cambria, MD, Rena Beckerly, MD^*, Anne M. Donnelly, RN^*, and Michael Laposata, MD, PhD

From the *Division of Cardiac Anesthesia, Department of Anesthesia and Critical Care, Massachusetts General Hospital Heart Center, Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital Heart Center, Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital Vascular Center, and Division of Laboratory Medicine, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Massachusetts.

Address correspondence and reprint requests to Edwin G. Avery, MD, Department of Anesthesia and Critical Care, Massachusetts General Hospital Heart Center, 55 Fruit St., Boston, MA 02114. Address e-mail to eavery{at}partners.org.

Abstract

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.