Another Example of Devastating Complication of Heparin-Induced Thrombocytopenia Post-Cardiac Surgery Is Danaparoid the Culprit of Another Near Fatal Complication英文文献资料.docVIP

Int. J. Clinical Medicine, 2010, 1, 75-77 75 doi:10.4236/ijcm.2010.12014 Published Online November 2010 (http://www.SciRP.org/journal/ijcm) Another Example of Devastating Complication of Heparin-Induced Thrombocytopenia Post-Cardiac Surgery Karine Toledano, Fran?ois Bé?que, Donald Hickey,Jean-Francois Morin Department of Anesthesia and Cardiac Surgery, SMBD Jewish General Hospital, McGill University, Montreal, Canada. Email: {sgermain, jmorin, dhickey}@jgh.mcgill.ca, fbeique@ana.jgh.mcgill.ca Received August 18 , 2010; revised September 2 , 2010; accepted September 2 , 2010. th nd nd ABSTRACT We describe a patient who developed catastrophic consequences of heparin-induced thrombocytopenia (HIT) post car- diac surgery, for which she required reoperation using CPB. We also illustrate the impact of intraoperative transe- sophageal echocardiography (TEE) in the surgical management of this patient. Keywords: Danaparoid, Heparin-Induced Thrombocytopenia, Stroke, Emboli ure 1. A spiral CT of the chest revealed massive emboli in the right and left pulmonary arteries. A clinical diag- 1. Summary In 2004, a 51-year-old woman underwent coronary artery bypass grafting surgery complicated by heparin-induced thrombocytopenia with thrombosis 9 days post operatively. Because this patient was already anticoagulated with danaparoid, the decision was made to use this anticoagu- lant during cardiopulmonary bypass for extraction of thrombi from both atria and pulmonary arteries. Clots were observed in the surgical field despite recommended dosing. Post-operatively, this patient exhibited excessive bleeding requiring massive transfusion and suffered from a stroke. Failure of danaparoid anticoagulation in our patient reinforces the need for an alternative anticoagulant. nosis of heparin-ind