Emergency cardiopulmonary bypass in a bilaterally nephrectomized patient with a history of heparin-induced thrombocytopenia: successful reexposure to heparin

We present a case of emergency coronary artery bypass surgery in a bilaterally nephrectomized patient with a history of heparin-induced thrombocytopenia. The patient was reexposed short term to heparin during cardiopulmonary bypass and did not develop any complications related to heparin-induced thrombocytopenia. Despite intraoperative neutralization of heparin severe bleeding complications occurred, probably resulting from preoperative therapeutic anticoagulation with r-hirudin in conjunction with an increased half-life of more than 2 days.