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Perfusion, Vol. 15, No. 3, 257-260 (2000)
DOI: 10.1177/026765910001500312

Anticoagulation in extracorporeal circulation using recombinant hirudin: a case report

Sven Beholz

Department of Cardiothoracic Surgery, Heart and Diabetes Center Mecklenburg-Vorpommern, Klinikum Karlsburg, svenbeholz{at}aol.com

Herko Grubitzsch

Department of Cardiothoracic Surgery, Heart and Diabetes Center Mecklenburg-Vorpommern, Klinikum Karlsburg

Britta Bergmann

Department of Cardiothoracic Surgery, Heart and Diabetes Center Mecklenburg-Vorpommern, Klinikum Karlsburg

Hans-Georg Wollert

Department of Cardiothoracic Surgery, Heart and Diabetes Center Mecklenburg-Vorpommern, Klinikum Karlsburg

Lothar Eckel

Department of Cardiothoracic Surgery, Heart and Diabetes Center Mecklenburg-Vorpommern, Klinikum Karlsburg

Heparin-induced thrombocytopenia (HIT) is a severe complication following the application of heparin; antibodies against complexes of heparin and PDF4 initiate activation of platelets. This may lead to massive thrombembolism, which is associated with a slight and transient drop of platelets in HIT I or a drop below 50% after approximately 5 days in HIT II. Further administration of heparin has to be strictly avoided in these patients. Immunologic evidence for HIT can easily be obtained by the heparin-induced platelet aggregation assay. If anticoagulation is necessary, different, alternative drugs are available. Recombinant hirudin (r-hirudin) is a well-established drug for safe anticoagulation. Monitoring is possible by estimating the plasma level of r-hirudin from the ecarin-clotting time. We report a case of a patient with prosthetic aortic valve endocarditis and HIT II who suffered from massive postoperative bleeding requiring massive substitution of blood components and coagulants caused by free circulating r-hirudin due to the use of a hemofilter.


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