Key result
Direct thrombin inhibitors such as argatroban and bivalirudin were successfully used as alternative anticoagulants during multiple percutaneous coronary interventions in a patient with heparin-induced thrombocytopenia.
Case Report (n=1)
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In patients with heparin-induced thrombocytopenia undergoing coronary revascularization, the use of direct thrombin inhibitors instead of heparin is essential to prevent devastating thrombotic complications like acute stent thrombosis.
Heparin Induced Thrombocytopenia (HIT) is a rare disorder, which manifests as acute onset thrombocytopenia within five to fifteen days after exposure to heparin. The milder version of the disease may manifest as asymptomatic thrombocytopenia, which resolves with cessation of heparin. The more severe form presents with arterial and venous thrombi, profound thrombocytopenia and is associated with devastating consequences such as myocardial infarction, stroke, limb ischemia etc. The management of patients with HIT undergoing revascularization in the form of Percutaneous Coronary Intervention (PCI) and/or Coronary Artery Bypass Grafting (CABG) can be challenging and complicated by acute stent thrombosis and early graft closure. Management strategy consists of immediate discontinuation of all heparin products, alternative anticoagulation, and lifelong avoidance of heparin products. Here we describe the various challenges specifically associated with coronary re-vascularization in these patients, and the current treatment options available.
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Narasimha et al. (2016) conducted a case report in Heparin Induced Thrombocytopenia (HIT) and Coronary Artery Disease (n=1). Direct thrombin inhibitors (Argatroban and Bivalirudin) was evaluated. Direct thrombin inhibitors such as argatroban and bivalirudin were successfully used as alternative anticoagulants during multiple percutaneous coronary interventions in a patient with heparin-induced thrombocytopenia.
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