Severe argatroban-induced coagulopathy in a patient with a history of heparin-induced thrombocytopenia

Ann Thorac Surg. 2004 Dec;78(6):e89-91. doi: 10.1016/j.athoracsur.2004.04.037.

Abstract

Heparin-induced thrombocytopenia is a serious complication of heparin therapy, and it remains a therapeutic challenge in the subset of patients requiring cardiopulmonary bypass. Alternative anticoagulation strategies include lepirudin, danaparoid, bivalirudin, and argatroban, or a combination of unfractionated heparin with a platelet antagonist. Argatroban is eliminated by a hepatic route, making it a practical option for patients with renal insufficiency. However, the lack of an effective antidote poses a significant problem. We present a patient with a history of heparin-induced thrombocytopenia with thrombosis who underwent a redo aortic valve replacement. Although the level of anticoagulation achieved with argatroban was initially adequate, its persistence after the completion of cardiopulmonary bypass proved to be life threatening.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / adverse effects*
  • Aortic Valve / surgery
  • Aortic Valve Stenosis / surgery
  • Arginine / analogs & derivatives
  • Blood Coagulation Disorders / chemically induced*
  • Heart Valve Prosthesis Implantation
  • Heparin / adverse effects*
  • Humans
  • Male
  • Pipecolic Acids / adverse effects*
  • Sulfonamides
  • Thrombocytopenia / chemically induced*
  • Thrombosis / chemically induced

Substances

  • Anticoagulants
  • Pipecolic Acids
  • Sulfonamides
  • Heparin
  • Arginine
  • argatroban