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Anesth Analg 2004;98:1635-1639
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000114072.71353.D5

CARDIOVASCULAR ANESTHESIA

Reversal of Direct Thrombin Inhibition After Cardiopulmonary Bypass in a Patient with Heparin-Induced Thrombocytopenia

Greg Stratmann, MD, PhD*, Anil M. deSilva, MD*, Elaine E. Tseng, MD{dagger}, Julie Hambleton, MD{ddagger}, Michel Balea*, Anthony J. Romo, MD*, Michael J. Mann, MD{dagger}, Nancy L. Achorn, CCP§, William F. Moskalik, CCP§, and Charles W. Hoopes, MD{dagger}

Departments of *Anesthesia and Perioperative Care, {dagger}Surgery, and {ddagger}Medicine, University of California at San Francisco; and §Golden Gate Perfusion, Inc., San Francisco, California

Address correspondence and reprint requests to Greg Stratmann, MD, Department of Anesthesia and Perioperative Care, Mailbox 0464, Room U 368 P, Moffitt Hospital, 513 Parnassus Ave., San Francisco, CA 94143. Address e-mail to gstratmann{at}anesthesia.ucsf.edu

We treated persistent hemorrhage after cardiopulmonary bypass in a heart transplant recipient who had received anticoagulation with the direct thrombin inhibitor bivalirudin by a combination therapy aimed at reducing the plasma concentration of the thrombin antagonist (hemodialysis and modified ultrafiltration), increasing the concentration of thrombin at bleeding sites (recombinant factor VIIa), and increasing the plasma concentration of other coagulation factors (fresh frozen plasma and cryoprecipitate). The bleeding was controlled, and there was no thrombotic complication.

IMPLICATIONS: A combination of modified ultrafiltration, hemodialysis, and the administration of recombinant factor VIIa, fresh frozen plasma, and cryoprecipitate may reverse the anticoagulant effect of bivalirudin.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.