R-Hirudin (lepirudin, Refludan (R)) as alternative anticoagulation in heparin-induced thrombocytopenia during cardiopulmonary bypass

A 72-year-old patient with heparin-induced thrombocytopenia (HIT) and globa l cardiac decompensation underwent cardiac surgery using an extracorporeal circuit (ECC). For systemic anticoagulation r-Hirudin (lepirudin, Refludan( R)) was administered as a heparin substitute during extracorporeal circuit. During cardiopulmonary bypass (100 min) the concentration of r-Hirudin was between 2.9 and 4.6 mcg/ml under continuous infusion of r-Hirudin at betwee n 1.5 and 4.5 mcg/kg/ min. The operation was successful and during its cour se no abnormal bleeding or fibrin formation in the extracorporeal circuit w as observed. One hour after operation haemorrhage occurred and rethoracotomy was perform ed without discovering the cause of the surgical bleeding. After substituti on with fresh frozen plasma, thrombocytes and Prothromblex(R) the bleeding stopped on the operation day. The further postoperative course was uncomplicated. After 3 days the patien t came to nursing station and was discharged from hospital to a rehabilitat ion centre after 13 days. After a further 3 weeks he went home in a good ge neral condition.