Gasparovic Hrvoje, Nathan Nadia S, Fitzgerald Daniel, Aranki Sary F
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 2004 Dec;78(6):e89-91. doi: 10.1016/j.athoracsur.2004.04.037.
Heparin-induced thrombocytopenia is a serious complication of heparin therapy, and it remains a therapeutic challenge in the subset of patients requiring cardiopulmonary bypass. Alternative anticoagulation strategies include lepirudin, danaparoid, bivalirudin, and argatroban, or a combination of unfractionated heparin with a platelet antagonist. Argatroban is eliminated by a hepatic route, making it a practical option for patients with renal insufficiency. However, the lack of an effective antidote poses a significant problem. We present a patient with a history of heparin-induced thrombocytopenia with thrombosis who underwent a redo aortic valve replacement. Although the level of anticoagulation achieved with argatroban was initially adequate, its persistence after the completion of cardiopulmonary bypass proved to be life threatening.
肝素诱导的血小板减少症是肝素治疗的严重并发症，对于需要进行体外循环的患者亚组而言，它仍然是一个治疗挑战。替代抗凝策略包括使用比伐芦定、达那肝素、比伐卢定和阿加曲班，或普通肝素与血小板拮抗剂联合使用。阿加曲班通过肝脏途径消除，这使其成为肾功能不全患者的一个实用选择。然而，缺乏有效的解毒剂带来了一个重大问题。我们报告了一名有肝素诱导的血小板减少症伴血栓形成病史的患者，该患者接受了再次主动脉瓣置换术。尽管最初使用阿加曲班实现的抗凝水平是足够的，但体外循环结束后其持续作用被证明危及生命。
