Coagulopatía fulminante tras el uso de bivalirudina en un paciente diagnosticado de trombocitopenia inducida por heparina y sometido a cirugía cardiaca con circulación extracorpórea / Fulminant coagulopathy after bivalirudin use in a patient diagnosed with heparin-induced thrombocytopenia and subject to cardiac bypass surgery

Los pacientes que desarrollan trombocitopenia inducida por heparina, con anticuerpos anti-PF4-heparina positivos, pueden presentar eventos tromboembólicos, lo que supone contraindicación absoluta para la administración de heparina. Existen evidencias clínicas publicadas acerca de la seguridad y eficacia en la administración de bivalirudina cuando estos pacientes precisan la realización de una intervención con necesidad de anticoagulación sistémica y utilización de circulación extracorpórea. Presentamos el caso de un paciente diagnosticado de trombocitopenia inducida por heparina y anticuerpos anti-PF4-heparina positivos, que precisaba una intervención de triple recambio valvular y que tras la administración de bivalirudina, desarrolló coagulopatía fulminante. Este caso ilustra la dificultad de manejo de este tipo de pacientes, poniendo de manifiesto estrategias de prevención y tratamiento para evitar esta severa diátesis hemorrágica (AU)

Patiens with a previus history of heparin-induced thrombocytopenia are at higher risk for thromboembolic events, and heparin administration is formally contraindicated. Bivalirudin has been reported as an alternative therapy whenever an intervention that requires systemic anticuagulation and cardiopulmonary by-pass pump is needed. We present the case of a patient diagnosed with heparin-induced thrombocytopenia and heparin-PF4-(+), antibodies requiring a triple cardiac valve replacement who developed fulminant coagulopathy after bivalirudin administration. A discussion on the serius difficulties that the management of these types of patiens involves, as well as review of prevention strategies are presented (AU)

[Fulminant coagulopathy after bivalirudin use in a patient diagnosed with heparin-induced thrombocytopenia and subject to cardiac bypass surgery]. / Coagulopatía fulminante tras el uso de bivalirudina en un paciente diagnosticado de trombocitopenia inducida por heparina y sometido a cirugía cardiaca con circulación extracorpórea.

Patients with a previous history of heparin-induced thrombocytopenia are at a higher risk for thromboembolic events, and heparin administration is formally contraindicated. Bivalirudin has been reported as an alternative therapy whenever an intervention that requires systemic anticoagulation and cardiopulmonary by-pass pump is needed. We present the case of a patient diagnosed with heparin-induced thrombocytopenia and heparin-PF4 (+) antibodies requiring a triple cardiac valve replacement who developed fulminant coagulopathy after bivalirudin administration. A discussion on the serious difficulties that the management of these types of patients involves, as well as a review of prevention strategies are presented.