Abstract
Patients with a history of heparin-induced thrombocytopenia (HIT) type II typically require alternative anticoagulants in place of heparin for cardiac surgery, whereas knowledge about perioperative anticoagulation managements in subacute HIT is limited. We present a case involving a patient with subacute HIT II requiring urgent abdominal aortic replacement. Preoperatively, the patient had a PT-INR of more than 2.5 while warfarin therapy for HIT was continuously administered. After laparotomy, however, apparent thrombosis proved inadequate anticoagulation. Consequently, argatroban was continuously administered and aortic cross-clamping was completed uneventfully. The patient's clinical coagulation status was associated with intraoperative ACT measurements but not with PT-INR values. In such a case, hemostasis should be assessed by coagulation tests and clinical observations for bleedings-thrombosis in the surgical field as well. This case report supports the safe and effective use of argatroban during aortic cross-clamping in subacute HIT II patients.
