Case Reports

Alternative Anticoagulation during Cardiovascular Procedures in Pediatric Patients with Heparin-Induced Thrombocytopenia

Address correspondence to: Donald E. Felix, MD, The Heart Center at Arnold Palmer Hospital for Children, 92 West Miller Street, Orlando, FL 32806. E-mail: donald.felix@orlandohealth.com

Received: 23 November 2011
Accepted: 10 April 2012

Abstract

Patients with heparin-induced thrombocytopenia (HIT) that require anticoagulation for cardiovascular procedures represent a challenging and high-risk group. Bivalirudin and argatroban have been successfully used as alternative anticoagulants in adult patients with HIT. There have been few experiences published involving the pediatric population and controversy exists regarding the properties and optimal dosing of these drugs. This report describes the experience of managing two pediatric patients with HIT that underwent cardiovascular procedures requiring anticoagulation. Bivalirudin was used in both cases for anticoagulation during cardiopulmonary bypass, while argatroban was used without complications during cardiac catheterization. A description of perfusion and anticoagulation protocols is included.