Lung transplantation using argatroban in severe heparin-induced thrombocytopenia during extracorporeal membrane oxygenation: a case series
Research article published in General thoracic and cardiovascular surgery (2020)
Abstract
Lung transplantation during heparin-induced thrombocytopenia (HIT) is controversial and often considered a contraindication because of the risk of increased bleeding and thrombosis in the recipient. Although lung transplantation offers the best chance for cure in end-stage lung disease, the outcome after transplantation is still controversial in patients with HIT. In our center, two patients developed HIT type II during venovenous extracorporeal membrane oxygenation (ECMO) support for acute respiratory failure. They underwent successful lung transplantation using argatroban. The subsequent clinical course was uneventful except evacuation of post-operative hematoma in 1 patient, and they were discharged. Argatroban was successfully used during lung transplant surgery in patients who developed HIT type II during ECMO support. Further studies on the feasibility and safety of lung transplantation using a direct thrombin inhibitor in patients with HIT during ECMO are required.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed research on anticoagulant and antithrombotic agents relevant to leech-derived compounds and thrombosis management. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This case series describes two patients who developed heparin-induced thrombocytopenia (HIT) type II during venovenous ECMO support for acute respiratory failure and then underwent successful lung transplantation anticoagulated with argatroban, a direct thrombin inhibitor, with an uneventful course aside from one post-operative hematoma evacuation. The connection to ASH's drug-discovery story is mechanistic: the medicinal-leech secretome is the origin of hirudin and modern direct thrombin inhibitors, and this report illustrates how thrombin inhibition serves as a heparin alternative in high-stakes surgery where heparin is contraindicated. The caveat is substantial: this is a two-patient case series describing argatroban (a synthetic agent), not leech therapy or leech-derived hirudin, and the authors explicitly call for further studies on feasibility and safety, so it offers only anecdotal, hypothesis-generating support for the thrombin-inhibitor class.
Citation
Lung transplantation using argatroban in severe heparin-induced thrombocytopenia during extracorporeal membrane oxygenation: a case series.
Lee et al. · General thoracic and cardiovascular surgery, 2020
Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026