Background

Heparin-induced thrombocytopenia rules out the possibility of adopting heparin for cardiopulmonary bypass. To overcome this problem two anticoagulants can be used: argatroban and bivalirudin.

Case presentation

We report on the adoption of argatroban during cardiopulmonary bypass for heart transplantation in a patient affected by HIT, previously implanted with a left ventricular assist device. Despite appropriate dosing, anticoagulation reversal proved ineffective, resulting in uncontrollable coagulopathy and fatal haemorrhage.

Conclusions

Argatroban could be an effective option for selected patients but more studies and particular attention are required, especially in patients with previous left ventricular assist device implantation.