The Use of Argatroban for Carotid Endarterectomy in Heparin-Induced Thrombocytopenia

In Brief Heparin-induced thrombocytopenia (HIT) is a major obstacle in cardiovascular surgeries. In this case report, we used argatroban, a direct thrombin inhibitor, to achieve and maintain anticoagulation for carotid endarterectomy. Unlike heparin, the direct thrombin inhibitors bind directly to thrombin, bypassing antithrombin III and the potential to precipitate HIT. A bolus of argatroban 150 μg/kg followed by an infusion of 5 μg · kg−1 · min−1 was used, and adequate anticoagulation was demonstrated with multiple laboratory tests (at 28 min, prothrombin time = 29.8 s, partial thromboplastin time = 69.1 s, international normalized ratio = 3.52 s, and activated clotting time = 220 s). The surgery was successful, and the patient was discharged the next day with no postoperative neurologic sequelae or other complications. We conclude that argatroban can be used safely and successfully for carotid endarterectomy in a patient with a history of HIT. IMPLICATIONS: Advances are being made to provide adequate anticoagulation when required in patients with heparin-induced thrombocytopenia. Direct thrombin inhibitors, such as argatroban, are increasingly being used for this purpose. We present a case during which we successfully used argatroban for carotid endarterectomy in such a patient.