Argatroban Usage For Anticoagulation for ECMO on a Post-Cardiac Patient with Heparin-Induced Thrombocytopenia

Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon

^* Address correspondence to: Brian Mejak, CCP, Pediatric Perfusion, Doernbecher Children’s Hospital, Oregon Health & Science University, DCH85, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239. E-mail: mejakb@ohsu.edu

Abstract

We report a post-Norwood Stage I patient requiring ECMO support using Argatroban as an anticoagulant following diagnosis of heparin-induced thrombocytopenia (HIT). A 2.6 kg female was born with hypoplastic left heart syndrome and underwent a Norwood Stage I operation on day 4 of life. The patient weaned off cardiopulmonary bypass with no complications and was routinely placed on a ventricular assist device (VAD) for 3 days. Heparin was infused at a rate of 16–32 IU/kg/h to maintain an ACT of 160–180 seconds. Two days after VAD termination, the patient was placed on continuous veno– veno hemofiltration (CVVH). Shortly after CVVH, the patient was diagnosed with HIT and placed on an Argatroban infusion. Five days later, a VAD and subsequent ECMO was used because of decreasing left ventricular function, gross body edema, and poor renal function. This case report summarizes the use of Argatroban during VAD and ECMO support for a patient diagnosed with HIT.