Anticoagulation management for cardiopulmonary bypass using TEG® 6 s in a patient receiving both heparin and dabigatran.

IF 0.8 Q3 ANESTHESIOLOGY

JA Clinical Reports Pub Date : 2024-09-04 DOI:10.1186/s40981-024-00739-8

Yu Kawada, Nobuyuki Katori, Keiko Kaji, Shoko Fujioka, Tomoki Yamaguchi

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引用次数: 0

Abstract

Background: It is difficult to evaluate adequate dose of heparin for cardiopulmonary bypass (CPB) by activated clotting time (ACT) in a patient receiving both heparin and dabigatran because dabigatran can also prolong ACT. We evaluated the effect of dabigatran by thromboelastography (TEG) to determine adequate heparin dose for CPB.

Case presentation: An 81-year-old woman receiving both heparin and dabigatran was scheduled for an emergency surgical repair of iatrogenic atrial septal perforation. Although ACT was prolonged to 419 s, we performed TEG to distinguish anticoagulation by dabigatran from heparin comparing R in CK and CHK. As the results of TEG indicated residual effect of dabigatran, we reversed dabigatran by idarucizumab and then dosed 200 U/kg of heparin to achieve adequate anticoagulation for CPB by heparin.

Conclusions: TEG could help physicians to determine need for idarucizumab and also an adequate dose of heparin to establish appropriate anticoagulation for CPB.

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使用 TEG® 6 s 对同时接受肝素和达比加群治疗的患者进行心肺旁路术的抗凝管理。

背景：对于同时接受肝素和达比加群治疗的患者，很难通过活化凝血时间（ACT）来评估心肺旁路术（CPB）中肝素的适当剂量，因为达比加群也会延长ACT。我们通过血栓弹性成像（TEG）评估了达比加群的效果，以确定 CPB 所需的肝素剂量：一名同时服用肝素和达比加群的 81 岁女性被安排接受先天性房间隔穿孔的急诊手术修复。虽然 ACT 延长至 419 秒，但我们还是进行了 TEG 检查，通过比较 CK 和 CHK 的 R 值来区分达比加群和肝素的抗凝作用。由于 TEG 结果显示达比加群有残留作用，我们用伊达珠单抗逆转了达比加群，然后使用肝素 200 U/kg，以达到肝素对 CPB 的充分抗凝：TEG 可以帮助医生确定是否需要使用伊达珠单抗，以及是否需要使用足够剂量的肝素为 CPB 进行适当的抗凝治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JA Clinical Reports ANESTHESIOLOGY-

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

9 weeks

期刊介绍： JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.