Kawada Yu, Katori Nobuyuki, Kaji Keiko, Fujioka Shoko, Yamaguchi Tomoki
Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, 105-8461, Japan.
JA Clin Rep. 2024 Sep 4;10(1):54. doi: 10.1186/s40981-024-00739-8.
It is difficult to evaluate adequate dose of heparin for cardiopulmonary bypass (CPB) by activated clotting time (ACT) in a patient receiving both heparin and dabigatran because dabigatran can also prolong ACT. We evaluated the effect of dabigatran by thromboelastography (TEG) to determine adequate heparin dose for CPB.
An 81-year-old woman receiving both heparin and dabigatran was scheduled for an emergency surgical repair of iatrogenic atrial septal perforation. Although ACT was prolonged to 419 s, we performed TEG to distinguish anticoagulation by dabigatran from heparin comparing R in CK and CHK. As the results of TEG indicated residual effect of dabigatran, we reversed dabigatran by idarucizumab and then dosed 200 U/kg of heparin to achieve adequate anticoagulation for CPB by heparin.
TEG could help physicians to determine need for idarucizumab and also an adequate dose of heparin to establish appropriate anticoagulation for CPB.
对于同时接受肝素和达比加群治疗的患者，通过活化凝血时间（ACT）来评估体外循环（CPB）时肝素的合适剂量较为困难，因为达比加群也可延长ACT。我们通过血栓弹力图（TEG）评估达比加群的作用，以确定CPB时肝素的合适剂量。
一名81岁同时接受肝素和达比加群治疗的女性计划接受医源性房间隔穿孔的紧急手术修复。尽管ACT延长至419秒，但我们进行了TEG，通过比较CK和CHK中的R来区分达比加群和肝素的抗凝作用。由于TEG结果显示达比加群有残留作用，我们用依达赛珠单抗逆转达比加群，然后给予200 U/kg的肝素，以实现CPB时肝素的充分抗凝。
TEG可帮助医生确定是否需要使用依达赛珠单抗，以及确定肝素的合适剂量，以建立CPB时的适当抗凝。
