Abstract
We report the case of a 27-year-old woman with signs of heparin-induced thrombocytopenia and thrombosis (HITT) and left heart failure presenting for urgent implantation of a left ventricular assist device (LVAD). HITT can occur in 4.2-6.1% of patients with LVADs. If the patient remains hemodynamically stable, implantation can be delayed for several months until the heparin/PF-4 antibodies decline allowing the use of heparin on cardiopulmonary bypass, However, in most cases related to cardiogenic shock, surgery cannot be delayed. We present the case of a patient who underwent implantation of a HeartMate II LVAD and discuss management strategy using bivalirudin during cardiopulmonary bypass.
MeSH terms
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Adult
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Anticoagulants / adverse effects
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Anticoagulants / therapeutic use
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Antithrombins / therapeutic use
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Cardiopulmonary Bypass / methods
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Combined Modality Therapy
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Female
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Heart Diseases / chemically induced*
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Heart Diseases / diagnosis
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Heart Diseases / therapy*
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Heart Ventricles / surgery
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Heart-Assist Devices
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Heparin / adverse effects*
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Heparin / therapeutic use
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Hirudins
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Humans
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Peptide Fragments / therapeutic use
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Prosthesis Implantation / methods
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Recombinant Proteins / therapeutic use
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Thrombocytopenia / chemically induced*
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Thrombocytopenia / diagnosis
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Thrombocytopenia / therapy*
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Thrombosis / chemically induced*
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Thrombosis / diagnosis
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Thrombosis / therapy*
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Treatment Outcome
Substances
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Anticoagulants
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Antithrombins
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Hirudins
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Peptide Fragments
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Recombinant Proteins
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Heparin
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bivalirudin