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Survival after intravenous thrombin prior to cardiopulmonary bypass

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Abstract

We present a case of a patient undergoing aortic valve replacement being inadvertently administered 5000 U of bovine thrombin instead of heparin for anticoagulation for cardiopulmonary bypass. The labeling error was made within the operating room pharmacy. The key to survival of this patient was a rapid diagnosis, administration of antithrombin and heparin, and removal of cardiac and great vessel thrombi. It is recommended that point of care anesthesia providers `prepare heparin for cardiopulmonary bypass anticoagulation, as thrombin is not used in anesthetic practice and is not contained within anesthesia cabinet medication drawers.

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Authors and Affiliations

  1. The Department of Anesthesiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, P.O. Box 245114, 85724-5114, Tucson, AZ, USA

    Vance G. Nielsen, Samata R. Paidy, Camron A. Meek & Tiffany K. Thornton

  2. The Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA

    Scott D. Lick

Authors
  1. Vance G. Nielsen
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  2. Samata R. Paidy
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  3. Camron A. Meek
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  4. Tiffany K. Thornton
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  5. Scott D. Lick
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Corresponding author

Correspondence to Vance G. Nielsen.

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Nielsen, V.G., Paidy, S.R., Meek, C.A. et al. Survival after intravenous thrombin prior to cardiopulmonary bypass. Int J Legal Med 131, 485–487 (2017). https://doi.org/10.1007/s00414-016-1480-7

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  • DOI: https://doi.org/10.1007/s00414-016-1480-7

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