A 24-hour perioperative case study on argatroban use for left ventricle assist device insertion during cardiopulmonary bypass and veno-arterial extracorporeal membrane oxygenation.
A 24-hour perioperative case study on argatroban use for left ventricle assist device insertion during cardiopulmonary bypass and veno-arterial extracorporeal membrane oxygenation.
Perfusion. 2018 Dec 25;:267659118813043
Authors: Fernandes P, O'Neil M, Del Valle S, Cave A, Nagpal D
Abstract
A 44-year-old male with ongoing chest pain and left ventricular ejection fraction <20% was transferred from a peripheral hospital with intra-aortic balloon pump placement following a non-ST-elevation myocardial infarction (STEMI). The patient underwent emergent multi-vessel coronary artery bypass grafting requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) on post-operative day (POD)#9 secondary to cardiogenic shock with biventricular failure. Due to clot formation, an oxygenator change-out was necessary shortly after initiation. Following a positive heparin-induced thrombocytopenia (HIT) assay, a total circuit exchange was required to eliminate all heparin coating and argatroban was deemed the anticoagulant of choice due to acute kidney injury. On POD#24, the decision was made to implant a left ventricle assist device (LVAD) as a bridge to heart transplantation. There was difficulty achieving an activated clotting time (ACT) >400 s: multiple argatroban bolus doses were required, along with accelerated up-titration of infusion dosing. Despite maintaining an ACT >484 s, clot formation was observed in the cardiotomy rese...
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Fernandes P, O'Neil M, Del Valle S, Cave A, Nagpal D Tags: Perfusion Source Type: research
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