hirudin and Cardiac-Tamponade

The use of extracorporeal membrane oxygenation (ECMO) support for cardiac and respiratory failure has increased in recent years. Improvements in ECMO oxygenator and pump technologies have aided this increase in utilization. Additionally, reports of successful outcomes in supporting patients with respiratory failure during the 2009 H1N1 pandemic and reports of ECMO during cardiopulmonary resuscitation have led to increased uptake of ECMO. Patients requiring ECMO are a heterogenous group of critically ill patients with cardiac and respiratory failure. Bleeding and thrombotic complications remain a leading cause of morbidity and mortality in patients on ECMO. In this review, we describe the mechanisms and management of hemostatic, thrombotic and hemolytic complications during ECMO support.

Topics: Anticoagulants; Blood Coagulation; Blood Coagulation Tests; Cardiac Output, Low; Cardiac Tamponade; Extracorporeal Membrane Oxygenation; Hemolysis; Hemorheology; Hemorrhage; Heparin; Hirudins; Humans; Peptide Fragments; Purpura, Thrombocytopenic, Idiopathic; Recombinant Proteins; Respiratory Insufficiency; Thrombosis; von Willebrand Diseases

Topics: Angioplasty, Balloon, Coronary; Anticoagulants; Cardiac Tamponade; Coronary Vessels; Heart Injuries; Heparin; Heparin Antagonists; Hirudins; Humans; Peptide Fragments; Recombinant Proteins; Risk Assessment; Risk Factors; Selection Bias; Treatment Outcome

Successful management of acute cardiac tamponade secondary to coronary artery perforation during percutaneous coronary intervention (PCI) includes sealing off the site of perforation and pericardiocentesis. We report two cases of acute cardiac tamponade during PCI associated with the administration of bivalirudin, in which attempts at percutaneous pericardiocentesis failed, due to the present of thrombus, rather blood, in the pericardium.

Topics: Acute Disease; Aged, 80 and over; Angioplasty, Balloon, Coronary; Anticoagulants; Cardiac Tamponade; Coronary Artery Disease; Coronary Vessels; Female; Heart Injuries; Hemostatic Techniques; Hirudins; Humans; Male; Middle Aged; Peptide Fragments; Pericardiectomy; Pericardiocentesis; Recombinant Proteins; Stents; Sternotomy; Thrombosis; Treatment Failure; Ultrasonography; Wounds, Penetrating

The objective of this study is to analyze the clinical outcomes and treatment strategies of coronary wire perforations (WPs) in the era of heparin use compared to the era of bivalirudin use.. Percutaneous coronary intervention (PCI) advances have led to progressive decrease in complications. Therefore, complex coronary lesions such as chronic total occlusions and calcified lesions are being attempted with stiff/hydrophilic wires with resultant higher incidence of coronary WP.. A single-center retrospective data analysis of coronary perforation (CP) for the last 4 years with review of coronary angiograms was done and WPs were identified. A simple classification scheme based on angiographic appearance of CP was made: Type I ("myocardial stain," with no frank dye extravasation) and type II ("myocardial fan," with dye extravasation to pericardial cavity or cardiac chambers).. Overall incidence of CP was 0.49% (82/16,859). Of these 50 (61%) were caused by WP; 30 occurred with heparin use (Group A) and 20 with bivalirudin use (Group B). WPs always occurred in type B2/C lesions (100%) and commonly with use of hydrophilic guidewires (70%). Major adverse cardiac events and cardiac tamponade were frequent in group A (50%) and none in group B (0%); P < 0.01. All WP in group B responded to stopping anticoagulation and prolonged balloon inflation, while group A type II perforations frequently required additional interventions (pericardiocentesis, coil embolization).. Cardiac tamponade and major adverse cardiac events from WPs were less frequent with bivalirudin use compared to heparin use. This beneficial effect of bivalirudin may be explained on the basis of its short half-life and reversible thrombin inhibition property. Therefore, bivalirudin may offer a safer alternative for anticoagulation in complex PCI.

Topics: Aged; Angioplasty, Balloon, Coronary; Anticoagulants; Balloon Occlusion; Cardiac Tamponade; Cineangiography; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Female; Heparin; Heparin Antagonists; Hirudins; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Infarction; Peptide Fragments; Pericardiocentesis; Recombinant Proteins; Registries; Retrospective Studies; Treatment Outcome; Wounds, Penetrating

Topics: Angioplasty, Balloon, Coronary; Anticoagulants; Balloon Occlusion; Blood Coagulation; Cardiac Tamponade; Coronary Vessels; Heparin; Heparin Antagonists; Hirudins; Humans; Myocardial Infarction; Peptide Fragments; Pericardiocentesis; Recombinant Proteins; Treatment Outcome; Wounds, Penetrating

Topics: Blood Component Transfusion; Cardiac Tamponade; Cardiomyopathy, Dilated; Cardiopulmonary Bypass; Fibrinolytic Agents; Heart Transplantation; Hemodiafiltration; Hirudins; Humans; Male; Middle Aged; Postoperative Hemorrhage; Recombinant Proteins; Reoperation; Thoracotomy