心臓血管外科周術期におけるヘパリン起因性血小板減少症(HIT)の管理(<特集>血小板減少症とアフェレシス)

概要

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HIT is an adverse effect of heparin which requires prompt diagnosis and management because it can cause serious systemic thrombotic complications as well as a disturbance of extracorporeal circulation. Case 1 with ischemic cardiac disease, developed rapid onset type HIT during cardiopulmonary bypass. Exchange of artificial lung was needed due to acute elevation of trans-lung pressure. After coronary arterial grafting, argatroban was administered. The course of the patient was uneventful without thrombotic episode or graft occlusion. Case 2 developed typical onset of HIT on the 13th postoperative day after the replacement of a thoracic aorta. Frequent clot formation in the dialyser was noticed and was improved after systemic administration of argatroban. Six months after the initial operation, the patient was negative for PF4/ heparin antibody. The second operation was performed reusing unfractionated heparin without any problems. In the treatment of cardiovascular surgical patients, an early diagnosis of HIT is indispensable if thrombocytopenia is recognized during the perioperative period. Managing HIT should include discontinuing heparin and administration of an alternative anticoagulant according to the clinical status of each patient.
2012-02-29