| Title | Successful use of recombinant hirudin and its monitoring by ecarin clotting time in patients with heparin-induced thrombocytopenia undergoing off-pump coronary artery revascularization. | | Author(s) | Iqbal O, Tobu M, Aziz S, Gerdisch M, Da Valle M, Demir M, Hoppensteadt DA, Ahmad S, Walenga JM, Fareed J | | Institution | Department of Pathology, Loyola University Medical Center, 2160 S. First Ave., Building 102, Room 2646, Maywood, IL 60153, USA. oiqbal@lumc.edu | | Source | J Card Surg 2005 Jan-Feb; 20(1):42-51. | | MeSH | Aged
Anticoagulants
Blood Coagulation Tests
Coronary Artery Bypass, Off-Pump
Endopeptidases
Female
Fibrinolytic Agents
Heparin
Hirudins
Humans
Infusions, Intravenous
Injections, Intravenous
Male
Middle Aged
Recombinant Proteins
Thrombocytopenia
Time Factors
Treatment Outcome
| | Abstract | Refludan (lepirudin-rDNA for injection) is the first direct thrombin inhibitor approved by the United States FDA for anticoagulation to patients with heparin-induced thrombocytopenia (HIT). It was monitored by ecarin clotting time (ECT) assay in patients with HIT. Case histories and clotting parameters for three patients undergoing off-pump coronary artery revascularization procedure are discussed. The first patient received r-hirudin at a dose of 0.2 mg/kg intravenous (IV) bolus followed by 0.15 mg/kg/hour infusion. The second patient received 0.4 mg/kg IV bolus followed by infusion of 0.15 mg/kg/hour infusion. The third patient with renal failure received 0.2 mg/kg IV bolus followed by an infusion of 0.02 mg/kg/hour. Blood samples were drawn at baseline, 5 minutes post bolus and every 15 minutes during the coronary artery revascularization procedure. ECT was performed immediately on the citrated whole blood samples using the ECT cards in conjunction with the point-of-care, the thrombolytic assessment system (TAS) Analyzer (Pharmanetics, Raleigh, NC). The plasma samples were then analyzed for APTT and liquid ECT assay performed on a kinetic centrifugal analyzer (ACL 300 Plus). The ECT by cards was ideally maintained above 600 seconds during the surgical procedure. Additional boluses of Refludan were given as and when necessary (ECT < 600 sec) in order to maintain adequate anticoagulation. The calculated circulating concentrations of Refludan, following a bolus administration, based on the ECT cards, liquid ECT and APTT were 3.20 +/- 1.3, 3.51 +/- 1.35 and 2.02 +/- 1.19 microg/mL, respectively. | | Language | eng | | Pub Type(s) | Clinical Trial
Journal Article
| | PubMed ID | 15673409 |
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