Abstract
Direct thrombin inhibitors are heparin alternatives for anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia. We report a case of a large thrombus forming in the venous reservoir while using bivalirudin. We suggest that blood stasis associated with the full venous reservoir maintained in this case led to formation of a large thrombus at the top of the venous canister. Furthermore, activated clotting times may not accurately reflect the magnitude of anticoagulation when using direct thrombin inhibitors.
MeSH terms
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Anticoagulants / adverse effects*
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Anticoagulants / therapeutic use
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Antithrombins / adverse effects*
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Antithrombins / therapeutic use
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Cardiomyopathy, Dilated / surgery
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Fibrinolysis
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Heart Transplantation / methods*
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Heparin / adverse effects*
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Heparin / therapeutic use
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Hirudins / adverse effects*
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Humans
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Intra-Aortic Balloon Pumping
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Male
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Middle Aged
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Peptide Fragments / adverse effects*
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Peptide Fragments / therapeutic use
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Recombinant Proteins / adverse effects
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Recombinant Proteins / therapeutic use
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Thrombocytopenia / chemically induced*
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Thrombocytopenia / drug therapy*
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Thrombosis / blood*
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Treatment Failure
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Whole Blood Coagulation Time
Substances
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Anticoagulants
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Antithrombins
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Hirudins
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Peptide Fragments
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Recombinant Proteins
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Heparin
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bivalirudin