[HSF] Heparin Induced Thrombocytopenia and CABG

[Cysmd613 at aol.com]

I wanted to give follow up on the patient that I had presented who had 
heparin induced thrombocytopenia.
 
After she had been on refludan (lepirudin) for 5 days, her platelet count 
rose only to 88,000 then began to drop again.  We stopped the refludan.  Her 
heparin antibody came back positive again.  I operated on her yesterday after 
being off refludan for 48 hours.  I used angiomax (bivalirudin) as you had 
recommended.  I did CABG X 4 and everything went well.  I stopped the angiomax 
infusion as I was completing the last 2 grafts.  She also received pre operative 
platelets, as her count had dropped to 76,000.  After coming off pump she 
received 10 units of platelets, 2 units FFP and 10 units cryoprecipitate.  
Miraculously (?) she did not bleed significantly.  In the first hour she drained only 
180 cc, and this tapered down quickly.  She was extubated last night and is 
doing well.   Thank you to all who gave advice.
 
Carmi Stadlan



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