The authors present the case of a patient with heparin induced thrombocytopaenia who needed anticoagulation during the perioperative period of a third repeat cardiac operation without transfusions. Prostacyclin pretreatment was contraindicated because of critical aortic stenosis, heparinoids could not have been used due to necessity of postoperative anticoagulation. Recombinant hirudin was applied and its effect was monitored with ekarin coagulation time. Hirudin anticoagulation was continued until the proper INR was reached in the postoperative period. There were no intra- and postoperative complications detected, and there was no need for transfusion either. On his long-term follow-up, 6.5 years after the last cardiac surgery the patients was feeling well and had no complaints. CONCLUSION: Open heart operation of a patient with heparin induced thrombocythopenia can be performed safely by total anticoagulation with lepirudin if it is conducted by ecarin clotting time.
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