Emergency cardiac surgery and heparin resistance in a patient with essential thrombocythemia

JA Clinical Reports
Mika NakanishiToshihiro Imanishi

Abstract

A 66-year-old man with thrombocytosis was brought to our hospital to undergo removal of a left ventricular thrombus. He had developed cerebral infarction 6 days before presenting to the hospital and suffered from right incomplete hemiparalysis. Blood tests on admission revealed his platelet count to be 124.3 × 104/μl. The urgent removal operation was performed under general anesthesia. For carrying out extracorporeal circulation (ECC), approximately three times as much heparin as expected was needed, as well as antithrombin III (AT III) administration. This met the definition of heparin resistance. The thrombus was removed and surgical left ventricular reconstruction was performed. Aspirin and warfarin were initiated on postoperative day 5. A bone marrow biopsy was performed on postoperative day 8, which revealed hypercellular marrow with megakaryocyte proliferation, and the patient was diagnosed as having essential thrombocythemia (ET). Although hydroxycarbamide administration started on postoperative day 10, his platelet count increased to 290.7 × 104/μl on postoperative day 13. The counts descended gradually, and on postoperative day 34, his platelet count reached the normal range and he was discharged from the hospital. In ...Continue Reading

References

Nov 18, 2006·Journal of Thrombosis and Thrombolysis·Zekeriya NurkalemMehmet Eren
Feb 1, 2008·Journal of Cardiothoracic Surgery·Kashif AhmedStephen M Langley
Sep 26, 2008·La Revue de médecine interne·S Guermazi, R Znazen
Jun 15, 2010·Interactive Cardiovascular and Thoracic Surgery·Maria A Gutierrez-MartinJose M Barquero
Nov 26, 2010·American Journal of Hematology·Bernard Khor, Elizabeth M Van Cott
Jul 2, 2011·The Annals of Thoracic Surgery·Sudipta Sekhar DasSuraj Kumar Pradhan
Feb 15, 2013·Anesthesia and Analgesia·Alan Finley, Charles Greenberg
Sep 10, 2013·Interactive Cardiovascular and Thoracic Surgery·Gwyn W Beattie, Robert R Jeffrey

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Citations

Jun 22, 2018·Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia·Masahide EnomotoTohru Asai

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Methods Mentioned

BETA
infrared spectroscopy
biopsy
cardiac artery bypass
mitral valve plasty
plateletpheresis

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