Anticoagulant Monitoring Techniques in a Heparin-Induced Thrombocytopenia Patient Undergoing Cardiopulmonary Bypass Using Bivalirudin Anticoagulant

¹ North Shore University Hospital–Long Island University CW Post School of Cardiovascular Perfusion, Manhasset, New York
² New York University Medical Center, New York, New York

^* Address correspondence to: Richard Chan, BS, CCP North Shore University, Hospital Long Island University, CW Post, School of Cardiovascular Perfusion, Manhasset, NY 11030. E-mail: ehiscvp@aol.com

Abstract

Heparin is widely used as the anticoagulant of choice for cardiopulmonary bypass. However, some patients exposed to heparin therapies develop heparin-induced thrombocytopenia (HIT). Severe complications of HIT-induced thrombosis may lead to end-organ dysfunction and death. Bivalirudin, a hirudin analog, is an alternative anticoagulant that may be used in the patient with HIT without inducing thrombotic disorders. This case report provides a look at the successful use of bivalirudin as the sole anticoagulant in a patient diagnosed with HIT undergoing minimally invasive cardiothoracic surgery requiring cardiopulmonary bypass for severe mitral insufficiency. An 80-year-old male presented to the operating room for a minimally invasive mitral valve repair. Past medical history included mitral valve prolapse, atrial fibrillation, hypertension, and congestive heart failure. Preoperative evaluation noted the existence of HIT with heparin exposure 2 months prior. The decision was made to use bivalirudin as the sole anticoagulant for the operative procedure. Anticoagulation evaluation was performed with both high-does thrombin time (HiTT) and Celite activated clotting time tubes for comparison using a Hemochron device. Cardiopulmonary bypass was initiated, and the patient’s mitral valve was repaired using a 34-mm annuloplasty ring. The patient was successfully weaned from bypass. No complications or evidence of HIT exacerbation were noted in the postoperative course.