refludan and Heart-Failure

Anticoagulation management of patients with recent heparin-induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB) surgery is a serious challenge, and especially difficult in patients requiring urgent heart transplantation. As nonheparin anticoagulants during CPB bear a high risk of major bleeding, these patients are at risk of being taken off the transplant list. Short-term use of unfractionated heparin (UFH) for CPB, with restriction of UFH to the surgery itself, is safe and effective in patients with a history of HIT who test negative for antiplatelet factor 4 (PF4)/heparin antibodies. We present evidence that it is safe to expand the concept of UFH reexposure to patients with subacute HIT (ie, those patients with recent HIT in whom the platelet count has recovered but in whom anti-PF4/heparin IgG antibodies remain detectable) requiring heart transplantation, if they test negative by a sensitive functional assay using washed platelets. This can be lifesaving in patients with end-stage heart failure.

Topics: Adult; Anticoagulants; Arginine; Autoantibodies; Heart Failure; Heart Transplantation; Heparin; Hirudins; Humans; Male; Middle Aged; Pipecolic Acids; Platelet Factor 4; Recombinant Proteins; Sulfonamides; Thrombocytopenia

Topics: Anticoagulants; Cardiomyopathy, Hypertrophic; Cardiopulmonary Bypass; Female; Heart Failure; Heart Transplantation; Hemofiltration; Heparin; Hirudins; Humans; Middle Aged; Recombinant Proteins; Thrombocytopenia

A patient with triple heart valve disease, heparin-induced thrombocytopenia, and terminal renal insufficiency was treated successfully using lepirudin for anticoagulation of cardiopulmonary bypass (CPB) and during the postoperative course. Anticoagulatory monitoring was performed with ecarin clotting time during CPB and aPTT postoperatively.

Topics: Aged; Anticoagulants; Cardiopulmonary Bypass; Female; Follow-Up Studies; Heart Failure; Heparin; Hirudins; Humans; Kidney Failure, Chronic; Myocardial Ischemia; Recombinant Proteins; Thrombocytopenia

A 50-year-old patient presented with clinical symptoms of heart failure with orthopnoe and edema (NYHA IV).. Echocardiography revealed a dilated left ventricle with severely reduced left ventricular function and biventricular floating thrombi, due to dilatative cardiomyopathy.. With a heart failure medication clinical symptoms reduced and body weight decreased > 10 kg in 3 weeks. Due to the high-risk constellation, anticoagulation was performed with lepirudin and the biventricular thrombi were dissolved within 17 days. At this point in time, the patient suffered from petechial bleedings, hemoptysis and gross hematuria. Despite breaking anticoagulation and substitution of PPSB with not measurable fibrinogen, subarachnoid hemorrhage occurred leading to exitus letalis.. Lepirudin is a highly effective anticoagulant, that can induce severe hemorrhagic side effects in individual cases. The present case report demonstrates an immunological reaction as a rare cause with activation of prothrombin and formation of fibrin.

Topics: Antibody Formation; Cardiomyopathy, Dilated; Dose-Response Relationship, Drug; Echocardiography; Fatal Outcome; Fibrinolytic Agents; Heart Failure; Heart Ventricles; Hematuria; Hemoptysis; Hirudins; Humans; Male; Middle Aged; Prothrombin Time; Purpura; Recombinant Proteins; Subarachnoid Hemorrhage; Thrombosis

Topics: Anticoagulants; Drug Overdose; Heart Failure; Hemodiafiltration; Hemorrhage; Hirudins; Humans; Kidney Failure, Chronic; Male; Middle Aged; Partial Thromboplastin Time; Recombinant Proteins; Renal Dialysis