Objective: To asses the risk of acquired antithrombin III (AT III) deficit before heart surgery and consider countermeasures. Patient: A 50-year-old gentleman who suffered from congestive heart failure due to mitral valve regurgitation. Methods: We replaced the mitral valve with cardiopulmonary bypass. Activated clotting time (ACT) was not long enough even after general heparinization (300 U/Kg) for cardiopulmonary bypass. We measured the activity of antithrombin III and added a total 50000 units of heparin until ACT was over 400 sec. We noted low AT III activity (36.8%) and transfused 4 U of fresh frozen plasma (FFP) during surgery. Results: After administration of protamine (0.3 ml/Kg), ACT reached 137 sec. The hemostasis procedure was uneventful and the patient recovered well without a bleeding incident. Conclusion: Measurement of AT III activity just before the initiation of cardiopulmonary bypass is necessary to avoid insufficient anticoagulation such as antithrombin III deficit.
Coagulation time, activated ; Mitral Valve ; Cardiopulmonary Bypass ; Antithrombin III ; Replacement

BACKGROUND: Hemostatic function is regarded to be preserved after an off-pump coronary artery bypass grafting (CABG), compared to conventional CABG, and the preserved hemostatic function may increase thrombotic occlusion of the graft. We studied the changes of hemostatic variables in patients undergoing off-pump CABG, and compared to those of on-pump CABG. MATERIAL AND METHOD: We studied the changes of coagulation function in 11 patients who underwent off-pump CABG (group I), and compared them with those of 11 patients who underwent on-pump CABG and Dor procedure (group II). Coagulation status was evaluated by thromboelastography and blood coagulation test preoperatively, postoperative 1st day, 2nd day, 3rd day, and 5th day, respectively. RESULT: Among the variables measured by thromboelastography (such as r time, k time, alpha angle, and MA value) and blood coagulation test (such as factor VII, protein S, protein C, antithrombin III, activated protein C resistance test, plasminogen, D-dimer, prothrombin time, activated partial thromboplastin time, platelet count, hemoglobin, and fibrinogen), there were significant differences in the MA value, alpha angle, and platelet counts between the two groups. MA values were 140+/-72% and 153+/-98% in group I, and 87+/-27% and 78+/-28% in group II, at postoperative 3rd and 5th days, respectively (p<0.05). alpha angle was 122+/-92% in group I and 69+/-23% in group II at postoperative 3rd day (p=0.09). Platelet count was 63+/-55% in group I and 33+/-13% in group II at postoperative 3rd day (p<0.05). CONCLUSION: Patients who underwent off-pump CABG showed increased coagulability during postoperative periods, compared to those who underwent on-pump CABG. Our data suggest that aggressive perioperative anticoagulation therapy is warranted in patients undergoing off-pump CABG.
Activated Protein C Resistance ; Antithrombin III ; Blood Coagulation Tests ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Factor VII ; Humans ; Partial Thromboplastin Time ; Plasminogen ; Platelet Count ; Postoperative Period ; Protein C ; Protein S ; Prothrombin Time ; Thrombelastography ; Transplants