PMID- 25004020
OWN - NLM
STAT- MEDLINE
DCOM- 20150625
LR  - 20161125
IS  - 1473-5733 (Electronic)
IS  - 0957-5235 (Linking)
VI  - 25
IP  - 8
DP  - 2014 Dec
TI  - Management of anticoagulation during cardiopulmonary bypass in a patient with 
      allergy to heparin and heparin-like compounds: a case-report.
PG  - 900-3
LID - 10.1097/MBC.0000000000000152 [doi]
AB  - Hypersensitivity to heparin and heparin-like compounds is a rare condition that 
      represents therapeutic challenges for patients requiring a cardiopulmonary bypass 
      (CPB). We here report the case of a woman with a combined allergy to heparins 
      (fractionated and unfractionated), danaparoid and fondaparinux. She underwent a 
      mitral valve replacement under CBP using lepirudin for systemic anticoagulation. 
      The use of lepirudin instead of unfractionated heparin (UFH) in this setting has 
      many important implications. Lepirudin therapeutic index is narrow and so, 
      overdosing can lead to catastrophic bleeding, whereas underdosing can result in 
      clotting in the CPB tubing. Monitoring of lepirudin activity is essential. The 
      usual activated clotting time monitoring is not a reliable method to monitor 
      anticoagulation with lepirudin in the operating theater. Our experience suggests 
      that the diluted thrombin time provides a valuable alternative during CPB.
FAU - Balthazar, Severine
AU  - Balthazar S
AD  - aDivision of Anaesthesiology, Cliniques Universitaires Saint-Luc, Brussels, 
      Belgium bDivision of Anaesthesiology, Institut Universitaire de Cardiologie et de 
      Pneumologie de Quebec, Quebec, Canada cDivision of Haematology, Haemostasis and 
      Thrombosis Unit dDivision of Pneumology and Allergology Unit, Cliniques 
      Universitaires Saint-Luc, Brussels, Belgium.
FAU - Watremez, Christine
AU  - Watremez C
FAU - Vigneault, Louise
AU  - Vigneault L
FAU - Eeckhoudt, Stephane
AU  - Eeckhoudt S
FAU - Pirson, Francoise
AU  - Pirson F
FAU - Hermans, Cedric
AU  - Hermans C
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Blood Coagul Fibrinolysis
JT  - Blood coagulation & fibrinolysis : an international journal in haemostasis and 
      thrombosis
JID - 9102551
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - Y43GF64R34 (lepirudin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - Blood Coagulation/drug effects
MH  - *Cardiopulmonary Bypass
MH  - Drug Hypersensitivity
MH  - Drug Monitoring
MH  - Female
MH  - Heparin/*adverse effects
MH  - Hirudins
MH  - Humans
MH  - Mitral Valve/transplantation
MH  - Mitral Valve Insufficiency/*blood/pathology/surgery
MH  - Recombinant Proteins/therapeutic use
MH  - Thrombin Time
MH  - Thrombosis/*prevention & control
EDAT- 2014/07/09 06:00
MHDA- 2015/06/26 06:00
CRDT- 2014/07/09 06:00
PHST- 2014/07/09 06:00 [entrez]
PHST- 2014/07/09 06:00 [pubmed]
PHST- 2015/06/26 06:00 [medline]
AID - 10.1097/MBC.0000000000000152 [doi]
PST - ppublish
SO  - Blood Coagul Fibrinolysis. 2014 Dec;25(8):900-3. doi: 
      10.1097/MBC.0000000000000152.