Use of argatroban as anticoagulation for cardiopulmonary bypass during heart transplantation: A case report

BACKGROUND: Heparin-induced thrombocytopenia rules out the possibility of adopting heparin for cardiopulmonary bypass. To overcome this problem two anticoagulants can be used: argatroban and bivalirudin. CASE PRESENTATION: We report on the adoption of argatroban during cardiopulmonary bypass for heart transplantation in a patient affected by HIT, previously implanted with a left ventricular assist device. Despite appropriate dosing, anticoagulation reversal proved ineffective, resulting in uncontrollable coagulopathy and fatal haemorrhage. CONCLUSIONS: Argatroban could be an effective option for selected patients but more studies and particular attention are required, especially in patients with previous left ventricular assist device implantation.