Ishida Keiichi, Masuda Masahisa, Kohno Hiroki, Tamura Yusaku, Matsumiya Goro
Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
Department of Cardiovascular Surgery, Chiba Medical Center, Chiba, Japan.
Asian Cardiovasc Thorac Ann. 2015 Sep;23(7):869-71. doi: 10.1177/0218492314568106. Epub 2015 Jan 20.
Patients with antiphospholipid syndrome are at increased risk of developing thrombotic and hemorrhagic complications after cardiac surgery, and may have abnormal coagulation tests and develop thrombocytopenia after invasive procedures, which can complicate the perioperative management of anticoagulant therapy. We describe a patient with chronic thromboembolic pulmonary hypertension and antiphospholipid syndrome, who presented with prolonged activated partial thromboplastin and activated clotting times, and developed thrombocytopenia after the catheterization workup. We performed pulmonary endarterectomy and successfully managed anticoagulation by restricting heparin use at the time of surgery and monitoring the heparin effect by measuring heparin concentrations during cardiopulmonary bypass.
抗磷脂综合征患者心脏手术后发生血栓形成和出血并发症的风险增加，在侵入性操作后可能出现凝血试验异常并发生血小板减少，这会使抗凝治疗的围手术期管理复杂化。我们描述了一名患有慢性血栓栓塞性肺动脉高压和抗磷脂综合征的患者，该患者活化部分凝血活酶时间和活化凝血时间延长，在导管检查后出现血小板减少。我们进行了肺动脉内膜切除术，并通过在手术时限制肝素使用以及在体外循环期间测量肝素浓度来监测肝素效果，从而成功地管理了抗凝治疗。
