Key result
Maintaining antithrombin activity above 80% with antithrombin supplementation and heparin allowed for safe aortic valve replacement without thromboembolic or bleeding complications in a patient with inherited antithrombin deficiency.
Case Report (n=1)
No
Maintaining antithrombin activity above 80% with antithrombin III supplementation and heparin enables safe cardiopulmonary bypass and perioperative management in patients with inherited antithrombin deficiency.
Hypothesis-generating for antithrombin supplementation in inherited deficiency during cardiac surgery; prospective validation required before practice change.
先天性アンチトロンビン欠乏症患者の大動脈弁置換術における周術期管理の経験を報告する．症例は72歳女性で62歳時に下肢深部静脈血栓症から肺血栓塞栓症を来し，下大静脈フィルター挿入および肺動脈血栓除去術を施行された．そのさいに先天性アンチトロンビン欠乏症と診断され，以後ワーファリンによる抗凝固療法が開始された．今回大動脈弁狭窄症に対し大動脈弁置換術を施行した．入院時at活性53%と低値であり，ワーファリン投与を中止の上at Iii製剤補充とヘパリン投与を行い手術に臨んだ．術当日はat活性＞80%に維持し，通常どおりact値を基にヘパリンを用いた人工心肺管理を行い得た．周術期はワーファリンによる抗凝固療法を再開して，pt-Inrが目標域に達するまでat Iii製剤を補充しながらヘパリン投与を継続し，血栓症の合併なく軽快し退院した．
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Tanoue et al. (2014) conducted a case report in Inherited antithrombin deficiency and severe aortic stenosis (n=1). Perioperative antithrombin supplementation and heparin infusion was evaluated on Thromboembolic events and bleeding complications. Maintaining antithrombin activity above 80% with antithrombin supplementation and heparin allowed for safe aortic valve replacement without thromboembolic or bleeding complications in a patient with inherited antithrombin deficiency.
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