Hanano M, Takahashi H, Arakawa K, Igarashi Y, Takizawa S, Tatewaki W, Fuse I, Shibata A
First Department of Internal Medicine, Niigata University School of Medicine, Japan.
Hematol Pathol. 1991;5(1):27-31.
Three patients with consumption coagulopathy due to left atrial thrombosis associated with mitral valve disease are described. They had hypofibrinogenemia (0.7-1.7 g/L), mild thrombocytopenia (104-117 x 10(9)/L), and elevated fibrinos/fibrin degradation products (FDP) (20-64 micrograms/ml). Two patients had bleeding symptoms, and one of these also had two episodes of transient ischemic attack. One without bleeding symptoms had three episodes of transient ischemic attack and repeated retinal vein thrombosis. In two patients, preoperative anticoagulation with either heparin or nafamostat mesilate was followed by an increase in plasma fibrinogen level from 0.7 to 5.6 g/L and a decrease in FDP from 64 to 8 micrograms/ml in one patient, and fibrinogen from 1.0 to 2.8 g/L and FDP from 40 to 5 micrograms/mL in another patient. The mitral valve replacement and thrombectomy were performed uneventfully, and their coagulopathy disappeared thereafter. These three patients had a lower platelet count and a shorter platelet survival time than another three patients with mitral valve disease of a similar severity but without coagulopathy. Hemostatic evaluation should be performed in patients suspected of intracardiac thrombosis.
本文描述了3例因二尖瓣疾病合并左心房血栓形成导致消耗性凝血病的患者。他们存在低纤维蛋白原血症（0.7 - 1.7g/L）、轻度血小板减少（104 - 117×10⁹/L）以及纤维蛋白/纤维蛋白降解产物（FDP）升高（20 - 64μg/ml）。2例患者有出血症状，其中1例还发生过2次短暂性脑缺血发作。1例无出血症状的患者发生过3次短暂性脑缺血发作及反复视网膜静脉血栓形成。2例患者术前使用肝素或甲磺酸萘莫司他抗凝后，1例患者血浆纤维蛋白原水平从0.7g/L升至5.6g/L，FDP从64μg/ml降至8μg/ml；另1例患者纤维蛋白原从1.0g/L升至2.8g/L，FDP从40μg/ml降至5μg/ml。二尖瓣置换术和血栓切除术均顺利完成，此后他们的凝血病消失。这3例患者的血小板计数和血小板生存时间低于另外3例病情严重程度相似但无凝血病的二尖瓣疾病患者。对于疑似心内血栓形成的患者应进行止血评估。
