Lung transplantation using argatroban in severe heparin-induced thrombocytopenia during extracorporeal membrane oxygenation: a case series

• Published in: General thoracic and cardiovascular surgery 2020-12, Vol.68 (12), p.1565-1568
• Main Authors: Lee, Sung Kwang, Cho, Woo Hyun, Kim, Do Hyung, Yeo, Hye Ju
• Format: Article
• Language: English
• Subjects: Antibodies; Anticoagulants; Anticoagulants - adverse effects; Arginine - analogs & derivatives; Blood clots; Blood platelets; Cardiac Surgery; Cardiology; Case Report; Contraindications; Extracorporeal Membrane Oxygenation; Hematoma; Heparin - adverse effects; Humans; Lung Transplantation; Lung transplants; Medicine; Medicine & Public Health; Ostomy; Patients; Pipecolic Acids; Pulmonary arteries; Respiratory failure; Sulfonamides; Surgery; Surgical apparatus & instruments; Surgical Oncology; Thoracic Surgery; Thrombocytopenia; Thrombocytopenia - chemically induced; Thrombosis; Trends; Ventilation
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-020-01356-9

Lung transplantation during heparin-induced thrombocytopenia (HIT) is controversial and often considered a contraindication because of the risk of increased bleeding and thrombosis in the recipient. Although lung transplantation offers the best chance for cure in end-stage lung disease, the outcome after transplantation is still controversial in patients with HIT. In our center, two patients developed HIT type II during venovenous extracorporeal membrane oxygenation (ECMO) support for acute respiratory failure. They underwent successful lung transplantation using argatroban. The subsequent clinical course was uneventful except evacuation of post-operative hematoma in 1 patient, and they were discharged. Argatroban was successfully used during lung transplant surgery in patients who developed HIT type II during ECMO support. Further studies on the feasibility and safety of lung transplantation using a direct thrombin inhibitor in patients with HIT during ECMO are required