Argatroban as an alternative anticoagulant for patients with heparin allergy during coronary bypass surgery

Although heparin allergy is a rare but well-documented entity, anticoagulation management for cardiac surgery in patients with the heparin allergy has not been established due to its rarity. Here we report a case that shows our anticoagulation strategy during a coronary by-pass operation. A 67-year-old man with unstable angina pectoris developed an urticarial rash 10h after the second exposure to heparin. Results of the drug lymphocyte stimulation test were positive for porcine heparin, coumadin, and nicorandil. Off-pump coronary bypass surgery was successfully performed with argatroban as an alternative anticoagulant to heparin, with activated clotting time kept over 200s at the rate of 5 mug/kg per min of argatroban infusion.