血栓弹力图（TEG）改善了体外循环期间合并抗磷脂综合征的抗凝管理。
TEG improves anticoagulation management during cardiopulmonary bypass complicated by antiphospholipid syndrome.
作者信息
Nakajima Tomomi, Kato Hideyuki, Mathis Bryan J, Hiramatsu Yuji, Sakamoto Hiroaki
机构信息
Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
出版信息
J Card Surg. 2020 Jun;35(6):1354-1356. doi: 10.1111/jocs.14557. Epub 2020 Apr 17.
BACKGROUND AND AIM
Cardiopulmonary bypass (CPB) in antiphospholipid syndrome (APS) patients carries a high risk of thrombosis and hemorrhage. However, optimal anticoagulation surveillance methods have not been established and heparin optimization has not yet been totally validated as reflective of anticoagulation status.
METHODS AND RESULT
Here, a 45-year-old female with APS underwent mitral valvuloplasty due to infective endocarditis. We used a perioperative, in vitro, heparin-activated clotting time (ACT) titration line coupled with synergistic, intraoperative thromboelastography (TEG) to monitor coagulation activity. After the ACT target was reached, TEG monitored the suppression of both intrinsic and extrinsic coagulation activity throughout the surgery.
CONCLUSION
TEG thus provided valuable temporal information on both intrinsic and extrinsic coagulation suppression validating heparin-ACT titration targets.
背景与目的
抗磷脂综合征（APS）患者进行体外循环（CPB）时，发生血栓形成和出血的风险很高。然而，尚未确立最佳的抗凝监测方法，肝素优化作为反映抗凝状态的指标也尚未完全得到验证。
方法与结果
在此，一名45岁的APS女性患者因感染性心内膜炎接受二尖瓣成形术。我们使用围手术期体外肝素激活凝血时间（ACT）滴定线并结合术中协同血栓弹力图（TEG）来监测凝血活性。达到ACT目标后，TEG在整个手术过程中监测内源性和外源性凝血活性的抑制情况。
结论
TEG因此提供了关于内源性和外源性凝血抑制的有价值的时间信息，验证了肝素-ACT滴定目标。
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