Central European Journal of Medicine

, Volume 5, Issue 2, pp 150–153 | Cite as

Coronary arterial bypass surgery with beating heart in a patient with heparin-induced thrombocytopenia: Usage of thrombin inhibitor (Lepirudin; r-hirudin)

  • Bilgehan Erkut
  • Necip Becit
  • Serpil Diler
  • Munacettin Ceviz
Case Report


One of the most important adverse drug reactions that physicians encounter is the life-threatening prothrombotic syndrome known as heparin-induced thrombocytopenia (HIT). In patients with a history of heparin-induced thrombocytopenia and coronary arterial disease, alternative anticoagulatory regimens are needed during cardiac surgery for prevention of thrombosis. Treatment options for such patients now generally include the use of alternative anticoagulants such as lepirudin, bivalirudin, argatroban or danaparoid. In this article, we present a case where heparin-induced thrombocytopenia was properly performed coronary arterial bypass grafting by using lepirudin. (This sentence is confusing)


Lepirudin Heparin-induced thrombocytopenia Coronary arterial bypss surgery Heparin Anticoagulation 


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  1. [1]
    Greinacher A, Janssens U, Berg G, Böck M, Kwasny H, Kemkes-Matthes B, Eichler P, Völpel H, Pötzsch B, Luz M. Lepirudin (recombinant hirudin) for parenteral anticoagulation in patients with HIT, Circulation, 1999, 100, 587–593PubMedGoogle Scholar
  2. [2]
    Warkentin TE, Chong BH, Greinacher A. Heparin-induced thrombocytopenia: towards consensus, Thromb Haemost, 1998, 79, 1–7.PubMedGoogle Scholar
  3. [3]
    Amiral J, Marfaing-Koka A, Wolf M, Alessi MC, Tardy B, Boyer-Neumann C, Vissac AM, Fressinaud E, Poncz M, Meyer D. Presence of autoantibodies to interleucin-8 or neutrophil-activating peptide-2 in patients with heparin-associated thrombocytopenia, Blood, 1996, 88, 410–416PubMedGoogle Scholar
  4. [4]
    Greinacher A, Michels I, Mueller-Eckhardt C. Heparin associated thrombocytopenia: the antibody is not heparin specific, Thromb Haemost, 1992, 67, 545–549PubMedGoogle Scholar
  5. [5]
    Gajra A, Vajpayee N, Smith A, Poiesz BJ, Narsipur S. Lepirudin for anticoagulation in patients with heparin-induced thrombocytopenia treated with continuous renal replacement therapy, Am J Hematol, 2006, 82, 391–393CrossRefGoogle Scholar
  6. [6]
    Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol, 2003, 121, 535–555CrossRefPubMedGoogle Scholar
  7. [7]
    Warkentin TE, Roberts RS, Hirsh J, Kelton JG. An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients. Arch Intern Med, 2003, 163, 2518–2524CrossRefPubMedGoogle Scholar
  8. [8]
    Glock Y, Szmil E, Boudjema B, Boccalon H, Fournial G, Cerene AL, Puel P. Cardiovascular surgery and heparin-induced thrombocytopenia, Int Angiol, 1988, 7, 238–245PubMedGoogle Scholar
  9. [9]
    Blakeman B. Management of heparin-induced thrombocytopenia: a cardiovascular surgeon’s perspective, Semin Hematol, 1999, 36, 37–41PubMedGoogle Scholar
  10. [10]
    Lewis BE, Wallis DE, Berkowitz SD, Matthai WH, Fareed J, Walenga JM, Bartholomew J, Sham R, Lerner RG, Zeigler ZR, Rustagi PK, Jang IK, Rifkin SD, Moran J, Hursting MJ, Kelton JG. Argatroban anticoagulant therapy in patients with heparin-induced thrombocytopenia. Circulation, 2001, 103, 1838–1843PubMedGoogle Scholar
  11. [11]
    Greinacher A, Lubenow N. Recombinant hirudin in clinical practice: focus on lepirudin, Circulation, 2001, 103, 1479–1484PubMedGoogle Scholar
  12. [12]
    Singer RL, Mannion JD, Bauer TL, Armenti FR, Edie RN. Complications from heparin-induced thrombocytopenia in patients undergoing cardiopulmonary bypass, Chest, 1993, 104, 1436–1440CrossRefPubMedGoogle Scholar
  13. [13]
    Lee DH, Warkentin TE: Frequency of heparin-induced thrombocytopenia. In: Warkentin TE, Greinacher A, eds. Heparin-Induced Thrombocytopenia. 3rd ed. New York: Marcel Dekker, 2004, 107–163Google Scholar
  14. [14]
    Ganzer D, Gutezeit A, Mayer G. Potential risks in drug prevention of thrombosis—low-molecular-weight heparin versus standard heparin, Z Orthop Ihre Grenzgeb, 1999, 137, 457–461CrossRefPubMedGoogle Scholar
  15. [15]
    Farner B, Eichler P, Kroll H, Greinacher A. A comparison of danaparoid and lepirudin in heparin-induced thrombocytopenia, Thromb Haemost, 2001, 85, 950–957PubMedGoogle Scholar
  16. [16]
    Potzsch B, Madlener K, Seelig C, Riess CF, Greinacher A, Müller-Berghaus G. Monitoring of r-hirudin anticoagulation during cardiopulmonary bypass—assessment of the whole blood ECT, Thromb Haemost, 1997, 77, 920–925PubMedGoogle Scholar

Copyright information

© © Versita Warsaw and Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Bilgehan Erkut
    • 1
  • Necip Becit
    • 2
  • Serpil Diler
    • 2
  • Munacettin Ceviz
    • 2
  1. 1.Cardiovascular Surgery DepartmentErzurum Regional Training and Research HospitalErzurumTurkey
  2. 2.Cardiovascular Surgery DepartmentAtatürk University Medical FacultyErzurumTurkey

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