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Eur J Cardiothorac Surg 2001;19:525-527
© 2001 Elsevier Science NL

Case report

Budd–Chiari syndrome and heparin-induced thrombocytopenia

Clinic for Cardiovascular Surgery, University Hospital, CH-3010 Berne, Switzerland

Received 3 November 2000; received in revised form 31 January 2001; accepted 16 February 2001.

Corresponding author. Tel.: +41-31-632-2375; fax: +41-31-632-4443
e-mail: thierry.carrel{at}insel.ch

We report on a patient suffering from Budd–Chiari disease who developed heparin-induced thrombocytopenia preoperatively. Dorsocranial liver resection and hepatoatrial anastomosis were performed with the extracorporeal circulation and perioperative anticoagulation was achieved with r-hirudin. Surprisingly, thrombus formation was observed in the venous reservoir although ACT was 590 s and aPTT 55 s. An additional bolus of hirudin and rinsing the reservoir allowed unproblematic discontinuation of the cardiopulmonary bypass.

Key Words: Budd–Chiari • Thrombocytopenia • Perioperative anticoagulation