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Epoprostenol Therapy for a Pediatric Patient With Subacute Heparin-Induced Thrombocytopenia and a Ventricular Assist Device Undergoing Heart Transplant

A Case Report

Navaratnam, Manchula, MBChB, FRCA*; Williams, Glyn D., MBChB, FFA (SA)*; Shuttleworth, Paul, BSN, MBA, CCP; Almond, Chris, MD; Maeda, Katsuide, MD, PhD§

doi: 10.1213/XAA.0000000000000818
Case Reports

Concerns remain regarding the use of direct thrombin inhibitors for cardiopulmonary bypass anticoagulation in pediatric patients with heparin-induced thrombocytopenia undergoing complex cardiac surgery. We describe the safe and effective use of epoprostenol sodium as an alternative therapy before heparin exposure for a pediatric patient with subacute heparin-induced thrombocytopenia and a ventricular assist device undergoing heart transplant.

From the *Department of Anesthesiology, Perioperative and Pain Medicine

Department of Cardiovascular Perfusion, Stanford Hospital and Clinics

Division of Cardiology, Department of Pediatrics

§Department of Cardiothoracic Surgery, Stanford Children’s Hospital, Stanford University Medical Center, Palo Alto, California.

Accepted for publication May 8, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Manchula Navaratnam, MBChB, FRCA, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Children’s Hospital, Stanford University Medical Center, Palo Alto, CA. Address e-mail to

© 2018 International Anesthesia Research Society
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