Shomura Shin, Katayama Yoshihiko, Kusagawa Hitoshi, Komada Takuya
Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan.
Kyobu Geka. 2014 Mar;67(3):203-6.
We report a case of chronic aortic dissection and angina pectoris with idiopathic thrombocytopenic purpura treated perioperatively with eltrombopag. A 72-year-old man was admitted to our hospital because of significant enlargement of an ulcer-like projection in the thoracic aorta revealed by chest computed tomography after acute aortic dissection. Laboratory data showed thrombocytopenia with idiopathic thrombocytopenic purpura. Eltrombopag was administered 12.5 mg daily and increased by 12.5 mg every 2 weeks until 37.5 mg/day to control idiopathic thrombocytopenic purpura(ITP). After 7 weeks' eltrombopag therapy, thrombocyte increased, and the patient underwent total arch replacement. Nine months later, coronary angiography revealed progression of coronary artery stenosis at the left main trunk. The patient underwent off-pump coronary artery bypass grafting 10 days after initiation of eltrombopag therapy. His postoperative course was uneventful. Eltrombopag was suggested to be effective in perioperative management in a patient with idiopathic thrombocytopenic purpura undergoing cardiovascular surgery.
我们报告了一例慢性主动脉夹层合并心绞痛且患有特发性血小板减少性紫癜的患者，围手术期使用艾曲泊帕进行治疗。一名72岁男性因急性主动脉夹层后胸部计算机断层扫描显示胸主动脉出现溃疡样突出物显著增大而入住我院。实验室检查数据显示为特发性血小板减少性紫癜伴血小板减少。每天给予艾曲泊帕12.5毫克，并每2周增加12.5毫克，直至37.5毫克/天，以控制特发性血小板减少性紫癜（ITP）。经过7周的艾曲泊帕治疗后，血小板增多，患者接受了全主动脉弓置换术。9个月后，冠状动脉造影显示左主干冠状动脉狭窄进展。在开始使用艾曲泊帕治疗10天后，患者接受了非体外循环冠状动脉旁路移植术。其术后病程平稳。对于接受心血管手术的特发性血小板减少性紫癜患者，艾曲泊帕被认为在围手术期管理中有效。
