[Challenging perioperative anticoagulation in a patient with Budd-Chiari syndrome and heparin-induced thrombocytopenia].

We report on a patient suffering from Budd-Chiari disease who developed heparin-induced thrombocytopenia preoperatively. Dorsocranial liver resection and hepatoatrial anastomosis were performed with the extracorporeal circulation and perioperative anticoagulation was achieved with r-hirudin. Surprisingly, thrombus formation was observed in the venous reservoir although intraoperative anticoagulation values were within the targeted level. An additional bolus of hirudin and rinsing the reservoir allowed unproblematic discontinuation of the cardiopulmonary bypass.