肝素诱导的血小板减少症患者心脏外科手术期间抗凝治疗

Anticoagulation strategy for patients with heparin-induced thrombocytopenia during cardiac surgery

目的术前诊断肝素诱导的血小板减少症(HIT)患者需要进行心脏外科手术时面临较大的挑战。本文旨在为HIT患者行心脏外科手术期间的抗凝策略提供新的选择。方法回顾了近期本院3例术前诊断HIT、术中使用替代肝素抗凝实施心脏手术的患者的病历资料,结合近年来文献报道讨论了直接凝血酶抑制剂(DTI)中阿加曲班和比伐卢定在各种心脏外科手术中的使用方法和剂量、监测指标、安全性、有效性、临床效果和注意事项等。结果 3例患者手术均行全麻下非停跳冠状动脉旁路移植术(OPCAB),过程顺利,恢复良好,2例患者术后胸液量较多使用血制品。结论在严密的抗凝监测下,阿加曲班和比伐卢定用于HIT患者心脏OPCAB是安全有效的。

Objective Patients with a diagnosis of heparin-induced thrombocytopenia（ HIT） who require cardiac surgery face great challenges. This article aims to provide new options for anticoagulation strategy during cardiac surgery for HIT patients. Methods We collected medical records of three patients with preoperative diagnosis of HIT who used direct thrombin inhibitors（ DTI） during cardiac operations. We reviewed the literatures and discussed method,dosage,monitoring indexes,safety,efficacy and limitation of different DITs. Results All three patients underwent OPCAB with general anesthesia,and the operations were successful without main complications. Conclusion It is safe and effective to use argatroban and bivarudin during OPCAB in patients with HIT under strict anticoagulation monitoring.