Heparin Anticoagulation during Cardiopulmonary Bypass for Thoracoabdominal Aorta Replacement in a Patient with a History of Heparin-Induced Thrombocytopenia
10.4326/jjcvs.39.144
- VernacularTitle:ヘパリン起因性血小板減少症既往のある症例に対するヘパリン使用体外循環下での胸腹部大動脈置換術
- Author:
Masanao Ohba
;
Hirokazu Murayama
;
Hiroyuki Kito
;
Kozo Matsuo
;
Naoki Hayashida
;
Souichi Asano
;
Masao Hirano
;
Shigeki Miyata
- Publication Type:Journal Article
- Keywords:
heparin-induced thrombocytopenia (HIT);
cardiopulmonary bypass;
thoracoabdominal aortic replacement
- From:Japanese Journal of Cardiovascular Surgery
2010;39(3):144-147
- CountryJapan
- Language:Japanese
-
Abstract:
Immune heparin-induced thrombocytopenia (HIT) is a crucial side effect of heparin therapy. We report the case of a 52-year-old man who was strongly suspected of having HIT after urgent descending aorta replacement. This case required continuous hemodiafiltration (CHDF) anticoagulated with unfractionated heparin (UFH) for acute renal failure after the operation. The patient developed thrombocytopenia and thrombus emphraxis in the circuit on the seventh day and was suspected of having HIT. UFH was ceased and replaced with argatroban. After then, thrombus emphraxis was not seen in the circuit and the platelet count was recovered promptly. He tested positive in an enzyme-linked immunosorbent assay for anti-platelet factor 4/heparin antibodies (anti-PF4/H Abs). Six months later, we found, an expanding thoracoabdominal aortic aneurysm and performed thoracoabdominal aorta replacement. We selected heparin anticoagulation for cardiopulmonary bypass because anti-PF4/H Abs were negative at that time. Thrombus emphraxis was not found during the operation. The patient developed neither thrombocytopenia nor thrombosis in the perioperative period.
