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Use of Argatroban in Donor Lung Procurement: A Case Report

Patient: Female, 57-year-old Final Diagnosis: Chronic obstructive pulmonary disease (COPD) Symptoms: Dyspnea • hypoxia Medication: — Clinical Procedure: Transplantation Specialty: Surgery • Transplantology OBJECTIVE: Unusual setting of medical care BACKGROUND: Heparin-induced thrombocytopenia (HIT)...

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Autores principales: Sharif, Limi, Millis, M. Andrew, Demarest, Caitlin T., Ela, Ashraf Abou El, McMurry, Katie A., Lyu, Dennis, Wakeam, Elliot
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594132/
https://www.ncbi.nlm.nih.gov/pubmed/34753898
http://dx.doi.org/10.12659/AJCR.934054
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author Sharif, Limi
Millis, M. Andrew
Demarest, Caitlin T.
Ela, Ashraf Abou El
McMurry, Katie A.
Lyu, Dennis
Wakeam, Elliot
author_facet Sharif, Limi
Millis, M. Andrew
Demarest, Caitlin T.
Ela, Ashraf Abou El
McMurry, Katie A.
Lyu, Dennis
Wakeam, Elliot
author_sort Sharif, Limi
collection PubMed
description Patient: Female, 57-year-old Final Diagnosis: Chronic obstructive pulmonary disease (COPD) Symptoms: Dyspnea • hypoxia Medication: — Clinical Procedure: Transplantation Specialty: Surgery • Transplantology OBJECTIVE: Unusual setting of medical care BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an immunological response to heparin exposure that predisposes patients to hypercoagulable reactions with subsequent heparin administration. Traditionally, heparin is the standard anticoagulant used during organ procurement to prevent clot formation in grafts. This creates a problem in donors or recipients that develop HIT as they are at risk of developing life-threatening coagulopathy. This raises the question of how to use alternative anticoagulation therapies, such as argatroban, that provide rapid-onset prophylaxis by reversibly inhibiting thrombin. Additionally, there are few studies that have assessed how recipients of multiorgan donors treated with argatroban do post-operatively. CASE REPORT: In this report, we discuss the procurement protocol and hospital course of a lung transplant recipient who received a graft treated with argatroban due to a HIT-positive liver recipient. The post-operative course for our patient was uneventful, with improved lung function and no complications attributable to argatroban use. Further, none of the 4 other recipients who received organs from the same donor experienced graft dysfunctions secondary to coagulopathy, including the HIT-positive liver recipient. CONCLUSIONS: The ultimate success of grafts without thromboembolic complications suggests the use of argatroban in multi-organ procurement in the setting of a HIT-positive recipient is safe and effective. This case report highlights an alternative to the traditional process of organ procurement with heparin, in which patients at risk of coagulopathies secondary to HIT are able to receive organs when traditional protocols would otherwise be prohibitive.
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spelling pubmed-85941322021-12-07 Use of Argatroban in Donor Lung Procurement: A Case Report Sharif, Limi Millis, M. Andrew Demarest, Caitlin T. Ela, Ashraf Abou El McMurry, Katie A. Lyu, Dennis Wakeam, Elliot Am J Case Rep Articles Patient: Female, 57-year-old Final Diagnosis: Chronic obstructive pulmonary disease (COPD) Symptoms: Dyspnea • hypoxia Medication: — Clinical Procedure: Transplantation Specialty: Surgery • Transplantology OBJECTIVE: Unusual setting of medical care BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an immunological response to heparin exposure that predisposes patients to hypercoagulable reactions with subsequent heparin administration. Traditionally, heparin is the standard anticoagulant used during organ procurement to prevent clot formation in grafts. This creates a problem in donors or recipients that develop HIT as they are at risk of developing life-threatening coagulopathy. This raises the question of how to use alternative anticoagulation therapies, such as argatroban, that provide rapid-onset prophylaxis by reversibly inhibiting thrombin. Additionally, there are few studies that have assessed how recipients of multiorgan donors treated with argatroban do post-operatively. CASE REPORT: In this report, we discuss the procurement protocol and hospital course of a lung transplant recipient who received a graft treated with argatroban due to a HIT-positive liver recipient. The post-operative course for our patient was uneventful, with improved lung function and no complications attributable to argatroban use. Further, none of the 4 other recipients who received organs from the same donor experienced graft dysfunctions secondary to coagulopathy, including the HIT-positive liver recipient. CONCLUSIONS: The ultimate success of grafts without thromboembolic complications suggests the use of argatroban in multi-organ procurement in the setting of a HIT-positive recipient is safe and effective. This case report highlights an alternative to the traditional process of organ procurement with heparin, in which patients at risk of coagulopathies secondary to HIT are able to receive organs when traditional protocols would otherwise be prohibitive. International Scientific Literature, Inc. 2021-11-10 /pmc/articles/PMC8594132/ /pubmed/34753898 http://dx.doi.org/10.12659/AJCR.934054 Text en © Am J Case Rep, 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Sharif, Limi
Millis, M. Andrew
Demarest, Caitlin T.
Ela, Ashraf Abou El
McMurry, Katie A.
Lyu, Dennis
Wakeam, Elliot
Use of Argatroban in Donor Lung Procurement: A Case Report
title Use of Argatroban in Donor Lung Procurement: A Case Report
title_full Use of Argatroban in Donor Lung Procurement: A Case Report
title_fullStr Use of Argatroban in Donor Lung Procurement: A Case Report
title_full_unstemmed Use of Argatroban in Donor Lung Procurement: A Case Report
title_short Use of Argatroban in Donor Lung Procurement: A Case Report
title_sort use of argatroban in donor lung procurement: a case report
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594132/
https://www.ncbi.nlm.nih.gov/pubmed/34753898
http://dx.doi.org/10.12659/AJCR.934054
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