Heparin-induced thrombocytopenia in a pediatric patient receiving extracorporeal support and treated with argatroban

Abstract

This report documents a pediatric case of HIT successfully treated with argatroban, allowing continuation of the venovenous extracorporeal membrane oxygenation and continuous renal replacement therapy, with resolution of the thromboembolic ischemia and thrombocytopenia.

A Case Series Describing the Use of Argatroban in Patients on Extracorporeal Circulation

“…Direct thrombin inhibitors (DTIs) are one treatment for patients who develop HIT, and their use has been extrapolated to those rare instances where patients on ECLS have HIT and are intolerant of standard anticoagulation with heparin. [1][2][3][4][5][6][7]9,15 In addition to reporting our experience in using argatroban for anticoagulation in ECLS, we report our method of titrating argatroban using ACTs to achieve anticoagulation. All five of our patients were started on argatroban because of the presence of antiplatelet factor IV antibodies and thrombocytopenia.…”

“…The DTIs are not dependent upon antithrombin III for their activity and inhibit both bound and unbound thrombin. Several case reports describe the use of argatroban as an anticoagulant in extracorporeal circulation [1][2][3][4][5][6][7][8][9] and experimental models of extracorporeal circulation. 10,11 Our objective was to examine the use of argatroban as an alternative to heparin for systemic anticoagulation during ECLS.…”

Prevalence of heparin-dependent platelet antibodies in children after cardiopulmonary bypass*

“…Typical options include direct thrombin inhibitors such as lepirudin and argatroban or a heparinoid such as danaparoid. There is less familiarity in using these agents in children (33)(34)(35)(36)(37)(38)(39), and adverse effects such as major bleeding have been reported (37)(38)(39). In addition, danaparoid, which is currently not available in the United States, has been associated with in vivo HDPA cross-reactivity of four of 33 (12%) (38).…”

Heparin-induced thrombocytopenia type II in an infant with a congenital heart defect???Anticoagulation during cardiopulmonary bypass with epoprostenol sodium and heparin

“…Whereas in adults different anticoagulant options for CPB have been described, in neonates the experience concerning the effective anticoagulation for the extracorporeal circulation is limited (9). Epoprostenol sodium is a prostaglandin (PGI 2 ), which inhibits intracellular adenylyl cyclase resulting in decreased platelet aggregation (10).…”