1: Surg Today. 2008;38(1):59-61. Epub 2007 Dec 24. 

Emergency pulmonary embolectomy during the second trimester of pregnancy: report  of a case. 

Taniguchi S, Fukuda I, Minakawa M, Watanabe K, Daitoku K, Suzuki Y. 

Department of Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan. 

We report a case of acute massive pulmonary thromboembolism, which occurred during the second trimester of pregnancy in a 35-year-old woman with thrombocytopenia and anemia secondary to myelodysplastic syndrome. We performed successful emergency pulmonary embolectomy, under cardiopulmonary bypass, using argatroban as an anticoagulant. An intra-aortic balloon pump was used to maintain placental blood flow. The patient recovered completely and was later delivered of a healthy baby. Thus, pulmonary embolectomy saved both the mother and the fetus. 

Publication Types:      Case Reports 

PMID: 18085366 [PubMed - indexed for MEDLINE] 

2: J Cardiothorac Vasc Anesth. 2007 Feb;21(1):113-26. Epub 2006 Oct 24. 

Alternative anticoagulation management strategies for the patient with heparin-induced thrombocytopenia undergoing cardiac surgery. 

Murphy GS, Marymont JH. 

Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, IL 60201, USA. dgmurphy2@yahoo.com 

Publication Types:      Review 

PMID: 17289495 [PubMed - indexed for MEDLINE] 

3: Blood Coagul Fibrinolysis. 2007 Jan;18(1):49-54. 

Hydroxyethyl starch enhances argatroban-mediated decreases in clot propagation and strength by diminishing thrombin-fibrinogen interactions. 

Nielsen VG, Kirklin JK. 

Department of Anesthesiology, The University of Alabama at Birmingham, Alabama 35249-6810, USA. vnielsen@uab.edu 

Direct thrombin inhibitors (DTIs) have been administered for anticoagulation during cardiopulmonary bypass for patients with heparin-induced thrombocytopenia. While DTIs prolonged clot initiation and decreased clot propagation, clot strength did not change. Hydroxyethyl starches (HES), however, significantly decreased clot propagation and strength. We hypothesized that DTI with HES could  significantly decrease hemostasis more than DTI alone.