Latrémouille C, Massonnet-Castel S, Baron J F, Renaudin J M, Cardon C, Fabiani J N, Carpentier A
Département de chirurgie cardiovasculaire, hôpital Broussis, Paris.
Arch Mal Coeur Vaiss. 1996 Oct;89(10):1305-9.
A patient with a Starr prosthetic heart valve for 13 years developed chronic idiopathic thrombocytopaenic purpura and a highly probable crossed allergy to heparin. As the valve needed to be replaced, cardiopulmonary bypass surgery was undertaken associating heparin with lioprost and Aprotinine. In this type of situation, aggregation of control platelets by the patient's plasma in the presence of unfractionated heparin and of low molecular weight heparin justifies the use of powerful antiplatelet agents such as lioprost which was associated with Aprotinine for its platelet protective effects. This original combination allowed successful cardiopulmonary bypass surgery under unfractionated heparin under excellent conditions with minimal blood loss. This case underlines the value of this approach for cardiopulmonary bypass surgery in patients with heparin-induced thrombocytopaenia.
一名植入斯塔尔人工心脏瓣膜13年的患者出现慢性特发性血小板减少性紫癜，且极有可能对肝素发生交叉过敏。由于需要更换瓣膜，遂进行体外循环手术，将肝素与前列地尔和抑肽酶联合使用。在这种情况下，患者血浆在普通肝素和低分子肝素存在时使对照血小板发生聚集，这证明使用强效抗血小板药物如前列地尔是合理的，前列地尔因其血小板保护作用而与抑肽酶联合使用。这种独特的联合用药使得在普通肝素作用下成功进行体外循环手术，手术条件极佳，失血极少。该病例凸显了这种方法在肝素诱导的血小板减少症患者进行体外循环手术中的价值。
