PMID- 14982973
OWN - NLM
STAT- MEDLINE
DCOM- 20040517
LR  - 20220408
IS  - 1060-0280 (Print)
IS  - 1060-0280 (Linking)
VI  - 38
IP  - 4
DP  - 2004 Apr
TI  - Lepirudin in heparin-induced thrombocytopenia and extracorporeal membranous 
      oxygenation.
PG  - 598-601
AB  - OBJECTIVE: To report a case of intermediate-probability suspected heparin-induced 
      thrombocytopenia (HIT) treated with lepirudin in a patient requiring continuous 
      extracorporeal membranous oxygenation (ECMO). CASE SUMMARY: A 17-year-old girl 
      was admitted with multiple traumatic injuries including severe bilateral 
      pulmonary contusions. Within 48 hours, she developed progressive pulmonary 
      failure despite mechanical ventilation, and was placed on ECMO. Anticoagulation 
      of the ECMO circuit was facilitated by unfractionated heparin (UFH). The platelet 
      count of 116 x 10(3)/mm(3) after initiation of ECMO gradually decreased over 5 
      days to 44 x 10(3)/mm(3). On ECMO day 5, a highly positive enzyme-linked 
      immunosorbent assay for HIT antibodies was reported, and the UFH infusion was 
      discontinued. Lepirudin was immediately started with a bolus of 0.1 mg/kg, 
      followed by an infusion of 0.12 mg/kg/h, with a target activated partial 
      thromboplastin time (aPTT) ratio approximately 2 times control. The ECMO circuit 
      was maintained without any unexpected bleeding complications or thrombosis for 6 
      additional days until the patient died secondary to pulmonary failure after ECMO 
      was removed. DISCUSSION: Use of ECMO typically requires continuous infusion of 
      UFH to keep the circuit from clotting. In patients with HIT, alternative 
      anticoagulation using a direct thrombin inhibitor may be warranted. Lepirudin was 
      effectively used to maintain the circuit despite continued presence of heparin 
      molecules impregnated into the ECMO circuit tubing. The aPTT was successfully 
      used to monitor and adjust the lepirudin infusion. CONCLUSIONS: In patients 
      requiring ECMO in the presence of HIT, anticoagulation of the ECMO circuit may be 
      accomplished using a continuous infusion of a direct thrombin inhibitor such as 
      lepirudin.
FAU - Dager, William E
AU  - Dager WE
AD  - Department of Pharmaceutical Services, University of California Davis Medical 
      Center, Sacramento, CA 95817-2201, USA. william.dager@ucdmc.ucdavis.edu
FAU - Gosselin, Robert C
AU  - Gosselin RC
FAU - Yoshikawa, Richard
AU  - Yoshikawa R
FAU - Owings, John T
AU  - Owings JT
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20040224
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - Y43GF64R34 (lepirudin)
SB  - IM
MH  - Adolescent
MH  - Anticoagulants/*adverse effects/*therapeutic use
MH  - Extracorporeal Membrane Oxygenation/*adverse effects
MH  - Fatal Outcome
MH  - Female
MH  - Heparin/*adverse effects
MH  - Hirudins/analogs & derivatives
MH  - Humans
MH  - Recombinant Proteins/*therapeutic use
MH  - Thrombocytopenia/chemically induced/*drug therapy
EDAT- 2004/02/26 05:00
MHDA- 2004/05/18 05:00
CRDT- 2004/02/26 05:00
PHST- 2004/02/26 05:00 [pubmed]
PHST- 2004/05/18 05:00 [medline]
PHST- 2004/02/26 05:00 [entrez]
AID - aph.1D436 [pii]
AID - 10.1345/aph.1D436 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2004 Apr;38(4):598-601. doi: 10.1345/aph.1D436. Epub 2004 Feb 
      24.