[Anesthetic management for a patient with heparin-induced thrombocytopenia (HIT) undergoing off-pump coronary bypass surgery using argatroban, a direct thrombin inhibitor].

HIT type II is one of the severe complications of heparin therapy. The antibody for the heparin-PF 4 complex, which causes thrombocytopenia of less than 100 x 10(3) microl(-1), thrombosis and DIC-like symptoms, is produced. We managed the patient with HIT type II undergoing off-pump CABG. Anesthesia was induced and maintained with fentanyl, midazolam, vecuronium and sevoflurane. The operation was performed using argatroban, a direct thrombin inhibitor, as an anticoagulant. Intraoperative activated coagulation time (ACT) was maintained above 250 sec with 2.5-5.0 microg x kg(-1) x min(-1) of argatroban infusion without bolus injection and all the procedures were successful.