Heparin-resistance in AL amyloidosis: a case report

被引：1

作者：

van Ede, Elisabeth S. ^{[1
]}

Hoeks, Marlijn P. A. ^{[2
]}

Hofland, Jan ^{[3
]}

Linssen, Vera D. ^{[3
]}

van Kuppevelt, Toin H. ^{[4
]}

Versteeg, Elly M. ^{[4
]}

Hafmans, Theo G. ^{[4
]}

Diepstra, Arjan ^{[5
]}

Kusters, Benno ^{[6
]}

Vermorgen, Sanne M. M. ^{[6
]}

机构：

[1] Radboudumc, Dept Intens Care Med, Nijmegen, Netherlands

[2] Radboudumc, Dept Hematol, Nijmegen, Netherlands

[3] Radboudumc, Dept Cardiothorac Anesthesiol, Nijmegen, Netherlands

[4] Radboudumc, Dept Biochem, Nijmegen, Netherlands

[5] Univ Med Ctr Groningen, Dept Hematopathol, Groningen, Netherlands

[6] Radboudumc, Dept Pathol, Nijmegen, Netherlands

来源：

BMC ANESTHESIOLOGY | 2023年 / 23卷 / 01期

关键词：

Anticoagulation; Perfusion; AL amyloidosis; Heparin Resistance; Case report; CARDIOPULMONARY BYPASS; ANTICOAGULATION; ARGATROBAN; BIVALIRUDIN;

D O I：

10.1186/s12871-023-02147-4

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

BackgroundNon-AT-III mediated heparin-resistance during CPB occurs by complex-forming with heparin-binding proteins. Currently, there are no specific recommendations for non-AT-III mediated heparin-resistance.Case presentationWe present a fatal case of a 70-yr-old male-patient undergoing cardiac-surgery in which refractory heparin-resistance was observed. The massive AL amyloidosis found at autopsy is thought to be responsible and illustrates that awareness and knowledge of the etiology and perioperative strategies of non-AT-III mediated heparin-resistance is important.ConclusionFor anticoagulation during cardiopulmonary bypass surgery in case of a non-AT-III medicated heparin resistance, we refer to the decision tree added to this manuscript and if necessary to consider direct thrombin inhibitors, such as bivalirudin or argatroban, as it bypasses the complexing pathway.

引用

页数：7

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