Kigawa Ikutaro, Okamura Yusuke, Fukuda Sachito, Miyairi Takeshi
Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Kyobu Geka. 2010 Jun;63(6):442-5.
We report herein a case of a patient who suffered heparin-induced thrombocytopenia (HIT) after on-pump coronary bypass grafting (CABG). A 62-year-old woman had received coronary angiography with heparin 4 months before CABG. She had been given heparin for 7 days before CABG, and underwent the operation under cardiopulmonary bypass uneventfully. She experienced thrombosis of multiple vein grafts without deep venous thrombosis or pulmonary embolism postoperatively. During percutaneous coronary intervention for residual coronary stenoses, acute multiple thromboses in coronary stents developed. We suspected HIT and administered argatroban instead of heparin. She recovered from shock after intra-aortic balloon pump insertion and balloon angioplasty for in-stent thromboses. HIT should be suspected whenever a thrombosis suddenly occurs in perioperative cardiac patients. Early diagnosis and treatment for HIT is essential to prevent subsequent thromboembolic events.
我们在此报告一例在体外循环冠状动脉搭桥术（CABG）后发生肝素诱导的血小板减少症（HIT）的患者。一名62岁女性在CABG前4个月接受了冠状动脉造影并使用了肝素。她在CABG前接受了7天肝素治疗，并在体外循环下顺利进行了手术。术后她出现了多条静脉移植物血栓形成，无深静脉血栓形成或肺栓塞。在对残余冠状动脉狭窄进行经皮冠状动脉介入治疗期间，冠状动脉支架内出现急性多发血栓形成。我们怀疑为HIT并给予阿加曲班替代肝素。在插入主动脉内球囊反搏并对支架内血栓进行球囊血管成形术后，她从休克中恢复过来。对于围手术期心脏患者，一旦突然发生血栓形成，就应怀疑HIT。对HIT进行早期诊断和治疗对于预防随后的血栓栓塞事件至关重要。
