Huebler Michael, Koster Andreas, Buz Semih, Boettcher Wolfgang, Hetzer Roland, Kuppe Herman, Dyke Cornelius M
Department of Cardiothoracic and Vascular Surgery, Deutsches Herssentrum Berlin, Germany.
J Card Surg. 2006 May-Jun;21(3):286-8. doi: 10.1111/j.1540-8191.2006.00233.x.
The presence of antibodies directed against heparin necessitates the use of an alternative anticoagulant in patients undergoing cardiac surgery. Bivalirudin is a short-acting direct thrombin inhibitor that has been used successfully in routine cardiac surgical cases. Experience in complicated cases requiring extended cardiopulmonary bypass is limited, however. We report the successful use of bivalirudin in a patient who underwent complex cardiac surgery.
A 42-year-old patient with aortic regurgitation due to endocarditis who had heparin antibodies underwent a Ross procedure for aortic valve replacement using bivalirudin as anticoagulant during cardiopulmonary bypass (CPB). Bivalirudin was given with a bolus of 1 mg/kg and a continuous infusion of 2.5 mg/kg/hours during CPB. Monitoring of bivalirudin was performed using the ecarin clotting time (ECT).
After 128 minutes of extracorporeal circulation, the patient was weaned from CPB without problems. After termination of CPB, modified ultrafiltration (MUF) was commenced. Perioperatively, six units of fresh frozen plasma were transfused. The 12-hour postoperative blood loss was 550 mL. The postoperative course was uneventful and the patient was discharged from hospital after 5 days.
Bivalirudin can be safely used for anticoagulation during CPB even in complex cardiac surgery.
对于接受心脏手术的患者，若存在针对肝素的抗体，则需要使用替代抗凝剂。比伐芦定是一种短效直接凝血酶抑制剂，已成功应用于常规心脏手术病例。然而，在需要延长体外循环的复杂病例中的经验有限。我们报告了比伐芦定在一名接受复杂心脏手术患者中的成功应用。
一名因心内膜炎导致主动脉瓣反流且有肝素抗体的42岁患者，在体外循环（CPB）期间使用比伐芦定作为抗凝剂接受了Ross手术以置换主动脉瓣。在CPB期间，比伐芦定给予1mg/kg的负荷剂量并以2.5mg/kg/小时的速度持续输注。使用蛇静脉酶凝结时间（ECT）对比伐芦定进行监测。
体外循环128分钟后，患者顺利脱离CPB。CPB结束后，开始进行改良超滤（MUF）。围手术期输注了6单位新鲜冰冻血浆。术后12小时失血量为550mL。术后过程顺利，患者5天后出院。
即使在复杂心脏手术中，比伐芦定也可安全地用于CPB期间的抗凝。
