Budd-Chiari syndrome and heparin-induced thrombocytopenia

We report on a patient suffering from Budd-Chiari disease who developed hep arin-induced thrombocytopenia preoperatively. Dorsocranial liver resection and hepatoatrial anastomosis were performed with the extracorporeal circula tion and perioperative anticoagulation was achieved with r-hirudin. Surpris ingly, thrombus formation was observed in the venous reservoir although ACT was 590 s and aPTT 55 s. An additional bolus of hirudin and rinsing the re servoir allowed unproblematic discontinuation of the cardiopulmonary bypass . (C) 2001 Elsevier Science B.V. All rights reserved.