Merino Elena, Abdelfattah Omar M
Department of Medicine, Morristown Medical Center, Atlantic Health System, 100 Madison Ave., Morristown, NJ 07960, USA.
Eur Heart J Case Rep. 2023 May 2;7(5):ytad231. doi: 10.1093/ehjcr/ytad231. eCollection 2023 May.
Patients with cardiogenic shock requiring temporary support with percutaneous ventricular assist device, such as Impella (Abiomed, Inc.), can develop heparin-induced thrombocytopenia (HIT) which requires use of alternative purge solution anticoagulation. There are limited recommendations on use of anticoagulation other than standard Unfractionated Heparin in 5% dextrose solution.
This case describes 69-year-old female who presented with symptoms of decompensated systolic heart failure and was found to be in cardiogenic shock and despite use of inotropes and vasopressors maintained low systolic blood pressure and low mixed venous oxygen saturation which lead to use of axillary Impella 5.0 (Abiomed, Inc.) who developed HIT. Purge solution anticoagulation was switched to Argatroban, but due to increased motor pressures, tissue plasminogen activator (tPA) was successfully used to maintain proper motor pressures. Ultimately, patient was transferred to an outside facility for a transplant evaluation.
This case demonstrates successful and safe use of tPA as an alternative purge solution although more data needed to support this finding.
需要使用经皮心室辅助装置（如Impella，Abiomed公司生产）进行临时支持的心源性休克患者，可能会发生肝素诱导的血小板减少症（HIT），这需要使用替代的冲洗液抗凝。除了在5%葡萄糖溶液中使用标准普通肝素外，关于其他抗凝剂使用的建议有限。
本病例描述了一名69岁女性，她出现了失代偿性收缩性心力衰竭的症状，被发现处于心源性休克状态，尽管使用了正性肌力药物和血管加压药，但收缩压仍维持在较低水平，混合静脉血氧饱和度也较低，这导致使用了腋动脉Impella 5.0（Abiomed公司生产），随后该患者发生了HIT。冲洗液抗凝改为阿加曲班，但由于动力压力增加，成功使用组织纤溶酶原激活剂（tPA）来维持适当的动力压力。最终，患者被转至外部机构进行移植评估。
本病例证明了tPA作为替代冲洗液的成功和安全使用，但需要更多数据来支持这一发现。
