Original Articles

Bivalirudin Anticoagulation for a Pediatric Patient with Heparin-Induced Thrombocytopenia and Thrombosis Requiring Cardiopulmonary Bypass for Ventricular Assist Device Placement

^* Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
^† Division of Cardiac Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
^‡ Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

Address correspondence to: Katie H. Faella, CCP, LP, Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail: Katie.Faella@cardio.chboston.org

Received: 14 December 2015
Accepted: 3 March 2016

Abstract

The direct thrombin inhibitor bivalirudin is an option for anticoagulation in patients with heparin induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB). There are a limited number of reports of pediatric patients in which bivalirudin has been used for anticoagulation for CPB. We present the case of an 11 year old male with acute onset heart failure secondary to idiopathic dilated cardiomyopathy that developed heparin induced thrombocytopenia with thrombosis (HITT). The patient was anticoagulated in the operating room with bivalirudin and placed on CPB for insertion of a HeartWare® Ventricular Assist Device (Heartware®). Modified techniques were utilized. This included use of the Terumo CDI 500 (Terumo Cardiovascular Systems, Inc.) in-line blood gas monitor which contains a heparin coated arterial shunt sensor. We flushed this sensor with buffered saline preoperatively and noted no significant decrease in platelet count postoperatively. The patient was successfully placed on the ventricular assist device and was subsequently listed for heart transplantation.