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Anesth Analg 2008; 106:404-408
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31815edb52
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CARDIOVASCULAR ANESTHESIOLOGY

Acute Left Atrial Thrombus After Recombinant Factor VIIa Administration During Left Ventricular Assist Device Implantation in a Patient with Heparin-Induced Thrombocytopenia

Ioanna Apostolidou, MD, Michael F. Sweeney, MD, Emil Missov, MD, PhD, Lyle D. Joyce, MD, Ranjit John, MD, PhD, and Richard C. Prielipp, MD, MBA

From the Department of Anesthesiology, University of Minneapolis, Minneapolis.

Address correspondence and reprint requests to Ioanna Apostolidou, MD, Department of Anesthesiology, University of Minneapolis, B515 Mayo, MMC 294, 420 Delaware St., S.E., Minneapolis, MN 55455. Address e-mail to apost015{at}umn.edu.

Abstract

We present a patient with end-stage heart failure and heparin-induced thrombocytopenia Type II, who required cardiopulmonary bypass (CPB) during a repeat implantation of a left ventricular assist device for long-term circulatory support. Bivalirudin was selected for anticoagulation during CPB, with concomitant infusion of aprotinin, in an effort to ameliorate blood loss. Nonetheless, profuse bleeding after CPB required massive transfusion of packed red blood cells, multiple coagulation factors, and platelets. Because of persistent bleeding, a single dose of recombinant factor VIIa (rFVIIa, 7.2 mg) was administered as rescue therapy. Within minutes, a large left atrial thrombus was detected by transesophageal echocardiography. We believe this is the first documentation of acute left atrial thrombus formation immediately after a single dose of recombinant factor VIIa administration during a left ventricular assist device implantation.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.