[A successful perioperative anticoagulation therapy and monitoring of a patient with hereditary plasminogen abnormality undergoing aortic valve replacement].

During perioperative period, plasminogen abnormality can result in unusual or unexplained clotting that occurs spontaneously or after minor trauma. However, there has been no report on perioperative anticoagulation therapy and monitoring in patients with hereditary plasminogen abnormality undergoing cardiac surgery. We performed a successful perioperative anticoagulation therapy and monitoring of a patient with hereditary plasminogen abnormality undergoing cardiac surgery. A 48-year-old male patient with severe aortic valve stenosis, who had had no episode of thrombosis, was scheduled for aortic valve replacement Preoperative laboratory screenings detected his abnormal plasminogen activity (7.6% normal), and he was diagnosed as hereditary plasminogen abnormality. Anesthetic course was uneventful until the initiation of cardiopulmonary bypass (CPB). During CPB, heparin level was monitored every 30 minutes by Hepcon/HMS (Medtronic Hemotec, Parker, CO). No thrombus was observed in the CPB circuit. Plasminogen activity, fibrin degradation products (FDP) and D-dimer were not elevated during perioperative period. Protamine dosage was determined by protamine titration method, and protamine was administrated after the termination of CPB. No major bleeding was observed after protamine administration. When the patient was admitted to ICU, anticoagulation therapy was started immediately. During perioperative period, no episode suggesting thrombosis was observed. In conclusion, we consider that this successful anticoagulation therapy and monitoring during CPB has been achieved by use of Hepcon/HMS.