Using a synthetic heparinoid, danaparoid (Orgaran), in two cardiopulmonarybypass procedures in a same patient with heparin-induced thrombocytopenia.

We report the case of a patient who underwent two cardiopulmonary bypass (C PB) procedures with Orgaran because of heparin-induced thrombocytopenia. A 38 years-old man with ischemic mitral insufficiency was operated for corona ry artery bypass and valvular replacement. The CPB was carried out with hep arin. Heparin-induced thrombocytopenia occured and was proven immunological ly. Two months later, a new valvular replacement was performed because of parav alvular leak due to endocarditis. The Orgaran-CPB protocol was as follows: 5,000 units before cardiopulmonary bypass, 5,000 units in the priming volum e, anti-Xa level between 0.9 and 1.1 units/mL, with injection of 1,500 unit s if necessary, no administration of protamine. One month later, a new valv ular replacement was necessary and performed with the same protocol using O rgaran. No bleeding or thrombotic complication occurred. Orgaran is a safe and reliable anti-thrombotic substitute if anti-Xa activi ty is closely monitored.