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Anesth Analg ; 98(6): 1635-1639, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15155316

ABSTRACT

UNLABELLED: We treated persistent hemorrhage after cardiopulmonary bypass in a heart transplant recipient who had received anticoagulation with the direct thrombin inhibitor bivalirudin by a combination therapy aimed at reducing the plasma concentration of the thrombin antagonist (hemodialysis and modified ultrafiltration), increasing the concentration of thrombin at bleeding sites (recombinant factor VIIa), and increasing the plasma concentration of other coagulation factors (fresh frozen plasma and cryoprecipitate). The bleeding was controlled, and there was no thrombotic complication. IMPLICATIONS: A combination of modified ultrafiltration, hemodialysis, and the administration of recombinant factor VIIa, fresh frozen plasma, and cryoprecipitate may reverse the anticoagulant effect of bivalirudin.


Subject(s)
Cardiopulmonary Bypass/methods , Heparin/adverse effects , Hirudins/analogs & derivatives , Thrombin/antagonists & inhibitors , Thrombocytopenia/chemically induced , Adult , Antithrombins/adverse effects , Antithrombins/pharmacology , Heparin/pharmacology , Hirudins/pharmacology , Humans , Male , Peptide Fragments/pharmacology , Peptide Fragments/therapeutic use , Recombinant Proteins/pharmacology , Recombinant Proteins/therapeutic use , Thrombocytopenia/therapy
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