[HSF] Heparin Induced Thrombocytopenia and CABG

[cysmd613 at aol.com]

Claudia,



I don't know whether the perfusionist did a TEG on this patient.? I will check with him, and if he did, I will let you know the results.



Carmi


-----Original Message-----
From: Claudia Teles <cvteles at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 25 Oct 2007 7:29 am
Subject: Re: [HSF] Heparin Induced Thrombocytopenia and CABG




It would be interesting to see the thromboelastography tracing of this
patient. An enlarged MCF and opened alpha angle indicate the
hypercoagulability of these patients. Mathematical manipulation of the
curves can also show the thrombotic risk of the patient.

claudia


2007/10/24, Cysmd613 at aol.com <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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-- 
Claudia Teles
Hemostasis Section - INCARDIO
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