Kurup Viji, Transue Sarah, Wu Yanyun, Rinder Henry M, Barash Paul, Dewar Michael
Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510-8051, USA.
Conn Med. 2006 Apr;70(4):245-50.
Heparin-induced thrombocytopenia (HIT) is being recognized in an increasing number of patients referred for cardiac surgery, as a result of previous exposure to heparin. We present a case of a patient with HIT scheduled for aortic valve replacement and coronary bypass graft surgery, who was managed with the direct thrombin inhibitor, argatroban for anticoagulation during cardiopulmonary bypass (CPB). The patient sustained continued bleeding in excess of the acknowledged half-life of the drug and required a substantial number of blood products to restore coagulation following CPB. Pertinent reports using argatroban for cardiac surgery with CPB are reviewed in the context of the present case report. The pharmacologic basis, cost analysis and resource utilization of heparin substitutes are discussed for the patient with HIT requiring CPB.
由于先前接触过肝素，越来越多接受心脏手术的患者被诊断出患有肝素诱导的血小板减少症（HIT）。我们报告一例计划进行主动脉瓣置换和冠状动脉搭桥手术的HIT患者，该患者在体外循环（CPB）期间使用直接凝血酶抑制剂阿加曲班进行抗凝治疗。患者在超过该药物公认半衰期的时间内持续出血，CPB后需要大量血液制品来恢复凝血功能。结合本病例报告，对使用阿加曲班进行CPB心脏手术的相关报告进行了综述。针对需要CPB的HIT患者，讨论了肝素替代品的药理基础、成本分析和资源利用情况。
