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Titolo:
HEPARIN-INDUCED THROMBOCYTOPENIA TYPE-II - PERIOPERATIVE MANAGEMENT USING DANAPAROID IN A CORONARY-ARTERY BYPASS PATIENT WITH RENAL-FAILURE
Autore:
WESTPHAL K; MARTENS S; STROUHAL U; MATHEIS G; LINDHOFFLAST E; WIMMERGREINECKER G; LISCHKE V;
Indirizzi:
UNIV FRANKFURT,ZENTRUM ANASTHESIOL & WIEDERBELEBUNG,DEPT ANAESTHESIOL& RESUSCITAT D-60590 FRANKFURT GERMANY UNIV FRANKFURT,DEPT THORAC & CARDIOVASC SURG D-60590 FRANKFURT GERMANY UNIV FRANKFURT,DEPT ANGIOL D-60590 FRANKFURT GERMANY
Titolo Testata:
The thoracic and cardiovascular surgeon
fascicolo: 6, volume: 45, anno: 1997,
pagine: 318 - 320
SICI:
0171-6425(1997)45:6<318:HTT-PM>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Keywords:
HEPARIN-INDUCED THROMBOCYTOPENIA; CARDIOPULMONARY BYPASS; KIDNEY FAILURE; DANAPAROID;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
7
Recensione:
Indirizzi per estratti:
Citazione:
K. Westphal et al., "HEPARIN-INDUCED THROMBOCYTOPENIA TYPE-II - PERIOPERATIVE MANAGEMENT USING DANAPAROID IN A CORONARY-ARTERY BYPASS PATIENT WITH RENAL-FAILURE", The thoracic and cardiovascular surgeon, 45(6), 1997, pp. 318-320

Abstract

An 84-year-old patient with heparin-induced thrombocytopenia (HIT), global cardiac decompensation, and acute renal failure underwent a cardiosurgical intervention using an extracorporeal circuit. For systemic anticoagulation danaparoid (Orgaran(R)) was applied as a heparin substitute preoperatively and maintained for systemic anticoagulation during ECC despite it being eliminated by the kidney. The postoperative recovery was prolonged due to bleeding complications. During cardiopulmonary bypass (216 min) the target level of anti-factor Xa was 1.5 Ul/ml. This required continuous infusion and an occasional bolus of danaparoid. Coagulation in the extracorporeal circuit was observed twice at plasma levels below 1.4 IU/ml. There were no thromboembolic or neurologic events. We did not retransfuse blood from the extracorporeal circuitor the cardiotomy reservoir after bypass, but because elimination of danaparoid was impaired in this patient and there is no neutraliser available antifactor Xa postoperatively exceeded 0.6 IU/ml for 30 hours. Diffuse bleeding with tamponade resulted. Weaning the patient from the respirator was achieved 12 hours after the last re-exploration. Fromthe 4(th) postoperative day 750 IU of danaparoid were administered twice daily subcutaneously for thrombosis prevention. On the 6(th) postoperative day discharge from the ICU was possible. We conclude that theapplication of danaparoid for cardiopulmonary bypass in patients suffering from acute renal failure may be complicated by hemorrhage.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 24/09/20 alle ore 19:31:19