Heparin-induced thrombocytopenia is a well-recognized complication of anticoagulation with heparin. We present the case of a patient with recent heparin-induced thrombocytopenia who subsequently needed surgery on an emergency basis for acute type A aortic dissection. This article reports the successful use of bivalirudin, a direct thrombin inhibitor, as an alternative to heparin throughout cardiopulmonary bypass and deep hypothermic circulatory arrest. We contend that bivalirudin is a safe alternative to heparin when performing surgery for aortic dissection and should be considered as an option for use in patients who present with heparin-induced thrombocytopenia.
Keywords: Anticoagulants/adverse effects; aortic dissection; bivalirudin; blood coagulation; blood loss, surgical; cardiopulmonary bypass; circulatory arrest, deep hypothermia induced; hemofiltration; heparin/adverse effects; hirudins; thrombocytopenia/chemically induced/prevention & control.