Key result
Lepirudin successfully managed anticoagulation in an infant with HIT requiring a bidirectional Glenn shunt, though dosing and monitoring were difficult.
Why the study?
Can lepirudin be safely used for anticoagulation in an infant with HIT requiring a bidirectional Glenn shunt?
Case Report (n=1)
Can lepirudin be safely used for anticoagulation in an infant with HIT requiring a bidirectional Glenn shunt?
Lepirudin can be used for anticoagulation during cardiac surgery in infants with HIT, but requires caution due to difficulties in monitoring the degree of anticoagulation.
Cautious lepirudin use may be feasible in infants with HIT needing cardiac surgery; leaves optimal dosing and monitoring open for research.
In Brief There are few reports of the management of pediatric patients with heparin-induced thrombocytopenia (HIT) requiring cardiac surgery using currently available anticoagulants. We report a case of an infant with HIT requiring a bidirectional Glenn shunt who was successfully managed using lepirudin (r-hirudin, Refludan; Aventis, Bridgewater, NJ). Dosing and monitoring of anticoagulation were difficult, and we suggest caution in the use of lepirudin for cardiac surgery unless reliable monitoring of the degree of anticoagulation becomes available. IMPLICATIONS: We present a case of a patient successfully managed using lepirudin; however, we advise caution in the use of this drug because it is difficult to appropriately measure the degree of anticoagulation.
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Iannoli et al. (2005) conducted a case report in Heparin-induced thrombocytopenia (HIT) with thrombosis (n=1). Lepirudin was evaluated on Successful surgical management. Lepirudin successfully managed anticoagulation in an infant with HIT requiring a bidirectional Glenn shunt, though dosing and monitoring were difficult.
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