Balthazar Séverine, Watremez Christine, Vigneault Louise, Eeckhoudt Stéphane, Pirson Françoise, Hermans Cédric
aDivision of Anaesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium bDivision of Anaesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada cDivision of Haematology, Haemostasis and Thrombosis Unit dDivision of Pneumology and Allergology Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Blood Coagul Fibrinolysis. 2014 Dec;25(8):900-3. doi: 10.1097/MBC.0000000000000152.
Hypersensitivity to heparin and heparin-like compounds is a rare condition that represents therapeutic challenges for patients requiring a cardiopulmonary bypass (CPB). We here report the case of a woman with a combined allergy to heparins (fractionated and unfractionated), danaparoid and fondaparinux. She underwent a mitral valve replacement under CBP using lepirudin for systemic anticoagulation. The use of lepirudin instead of unfractionated heparin (UFH) in this setting has many important implications. Lepirudin therapeutic index is narrow and so, overdosing can lead to catastrophic bleeding, whereas underdosing can result in clotting in the CPB tubing. Monitoring of lepirudin activity is essential. The usual activated clotting time monitoring is not a reliable method to monitor anticoagulation with lepirudin in the operating theater. Our experience suggests that the diluted thrombin time provides a valuable alternative during CPB.
对肝素和类肝素化合物过敏是一种罕见的情况，对于需要进行体外循环（CPB）的患者而言，这构成了治疗挑战。我们在此报告一名对肝素（低分子肝素和普通肝素）、达那肝素和磺达肝癸钠合并过敏的女性病例。她在体外循环下接受二尖瓣置换术，使用比伐卢定进行全身抗凝。在此情况下使用比伐卢定而非普通肝素（UFH）具有许多重要意义。比伐卢定的治疗指数较窄，因此，用药过量可导致灾难性出血，而用药不足则可导致体外循环管道内凝血。监测比伐卢定活性至关重要。常规的活化凝血时间监测并非在手术室中监测比伐卢定抗凝效果的可靠方法。我们的经验表明，稀释凝血酶时间在体外循环期间提供了一种有价值的替代方法。
