Furukawa Hiroshi, Konishi Toshio, Fukata Mutsumu, Okada Hiroshi, Sakagami Naoko, Kurosaki Kenji
Department of Cardiovascular Surgery, Yokohama Rosai Hospital, Yokohama, Japan.
Kyobu Geka. 2013 May;66(5):383-6.
Heparin-induced thrombocytopenia (HIT) is a life-threatening side effect of heparin therapy. We report an open heart surgery with cardiopulmonary bypass( CPB) using argatroban as an anticoagulant for a patient with HIT. A 72-year-old male with a history of percutaneous coronary intervention 5 years ago, was admitted to our hospital due to congestive heart failure and heparin 10,000 units/day was administered. At 10th hospital day, his platelet count was significantly decreased and antibodies positive for type II HIT was found, so he was diagnosed HIT. Echocardiogram and coronary angiography revealed severe functional mitral regurgitation and coronary stenosis. At 24th hospital day we performed coronary artery bypass grafting( CABG) and mitral valve replacement (MVR) with CPB using argatroban as an anticoagulant. During CPB, we monitored the activated clotting time (ACT) to adjust the dose of argatroban. Though the surgical procedure itself was uneventful. We required about 4 hours to achieve adequate hemostasis after CPB. Postoperative course was uneventful.
肝素诱导的血小板减少症（HIT）是肝素治疗的一种危及生命的副作用。我们报告了一例使用阿加曲班作为抗凝剂进行体外循环心脏直视手术的HIT患者。一名72岁男性，有5年前经皮冠状动脉介入治疗史，因充血性心力衰竭入院，每天给予肝素10000单位。住院第10天，他的血小板计数显著下降，发现II型HIT抗体呈阳性，因此他被诊断为HIT。超声心动图和冠状动脉造影显示严重的功能性二尖瓣反流和冠状动脉狭窄。住院第24天，我们使用阿加曲班作为抗凝剂进行了冠状动脉旁路移植术（CABG）和二尖瓣置换术（MVR）并进行了体外循环。在体外循环期间，我们监测活化凝血时间（ACT）以调整阿加曲班的剂量。尽管手术过程本身顺利。体外循环后我们需要大约4小时才能实现充分止血。术后过程顺利。
