[Use of argatroban during cardiopulmonary bypass for atrial septal defect with heparin induced thrombocytopenia after introduction of dialysis].

A 28-years-old woman living in Japan who was diagnosed as atrial septal defect from the childhood period was admitted for exacerbation of the congestive heart failure with the renal insufficiency. Immediately, hemodialysis was established, but her platelet count tended to decrease, and she was found to have antibodies positive for type II heparin-induced thrombocytopenia (HIT). About anticoagulation during cardiopulmonary bypass (CPB), activated clotting time (ACT) was maintained than 400 seconds, using the continuance dosage together with the bolus dosage of argatroban. Clotting blood has already concentrated on a pomp oxygenator before establishing CPB, therefore the CPB circuit and cannulas were changed newly, and the bleed in the operation site was not collected in a circuit until CPB was established. After that the operation was performed with no problem. No HIT related complications occurred in the postoperative period. And regular hemodialysis has been performed with argatroban for anticoagulation even today.