This is a case report about a 34-year-old patient who, after a five week wait in hospital, was offered a donor heart that had to be transplanted within 2 hours. Because of a history of heparin-induced thrombocytopenia (HIT), the patient had been placed preoperatively on the anticoagulation drug argatroban for which there is currently no reversal agent. Despite ceasing the continuous infusion of argatroban immediately, concentration only declined from 0.60 mug/ml to 0.58 mug/ml before surgery, with the activated clotting time (ACT) value remaining very high (223 s). Microvascular bleeding was observed on chest incision, therefore a CytoSorb column was integrated into the system of the heparin-anticoagulated cardiopulmonary bypass (CPB) circuit, with a flow of 400 mL/min provided during the 150 mins of extracorporeal circulation. The argatroban concentration after weaning from CPB was 0.04 mug/ml and satisfying hemostasis was achieved after protamine administration. Despite severe bleeding within the context of perioperative use of argatroban having been described, the 12-h postoperative blood loss was only 580 mL. The authors note that the availability of a technology for quick elimination of high therapeutic concentrations of argatroban may have a significant impact on the safety profile of this drug, and that the use of CytoSorb might be an effective tool that has the potential to fulfil these criteria.
Open-access publication: https://pubmed.ncbi.nlm.nih.gov/35619539/