Why the study?
Does intraoperative heparin prevent thrombus formation during digestive reconstruction in a patient with protein C deficiency?
Does intraoperative heparin prevent thrombus formation during digestive reconstruction in a patient with protein C deficiency?
Appropriate anticoagulation control, such as intraoperative heparin, is crucial to prevent thrombus formation and graft necrosis during reconstructive surgery in patients with protein C deficiency.
Thrombosis risk warrants caution with free jejunal grafts in protein C deficiency; leaves open optimal antithrombotic strategies for hypercoagulable patients.
A 63-year-old man with protein C deficiency underwent thoracoscopic esophagectomy and digestive reconstruction using a gastric tube for thoracic esophageal cancer. On postoperative day 3, the gastric tube was removed because of anastomotic leakage and gastric tube necrosis. Digestive reconstruction using a free jejunal graft was attempted 140 days after the first surgery. However, thrombus formation in the artery and vein of the jejunal graft resulted in a failed reconstruction. Ten days after this surgery, digestive reconstruction using the colon was performed with intraoperative heparin administered for anticoagulation control. The surgery was successful, with no thrombus formation afterward. When performing digestive reconstruction in patients with conditions predisposing to thrombus formation, perioperative management should be completed with careful attention toward preventing thrombus formation. In particular, appropriate anticoagulation control, such as the administration of intraoperative heparin, is recommended in patients with protein C deficiency because necrosis of the reconstructed organ is likely.
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Ujiie et al. (2020) studied this question.
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