Clopidogrel-related refractory bleeding after coronary artery bypass graft surgery: A rationale for the use of coagulation factor concentrates?

被引:13
|
作者
von Heymann, C
Schoenfeld, H
Sander, M
Ziemer, S
Grubitzsch, H
Spies, C
机构
[1] Charite Univ Med Berlin, Dept Anaesthesiol & Intens Care Med, D-10117 Berlin, Germany
[2] Charite Univ Med Berlin, Inst Lab Med & Pathol Biochem, D-10117 Berlin, Germany
[3] Charite Univ Med Berlin, Dept Cardiovasc Surg, D-10117 Berlin, Germany
来源
HEART SURGERY FORUM | 2005年 / 8卷 / 01期
关键词
D O I
10.1532/HSF98.20041122
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Clopidogrel, an irreversible ADP-receptor antagonist, inhibits platelet aggregation mediated by reduced activation of glycoprotein receptor IIb/IIIa. Clopidogrel in combination with aspirin has been shown to be superior to aspirin alone for treating unstable angina, but clopidogrel recipients have shown increases in blood loss, transfusion requirements, and rate of reoperation after cardiac surgery. We describe a patient who had taken clopidogrel 75 mg daily until the day prior to coronary artery bypass graft surgery. Severe postoperative bleeding developed and was refractory to conventional hemostatic therapy consisting of 19 units of packed red blood cell concentrates, 16 of fresh frozen plasma, 8 of platelet apheresis concentrates plus high-dose treatment with aprotinin (500.000 kallikrein-inhibiting units/h) and administration of 0.3 mu g/kg 1-deamino-8- D-arginine vasopressin (DDAVP). Two reoperations were performed, but surgical hemostasis was not achieved, so 100 mu g/kg recombinant activated factor VII was applied to generate sufficient thrombin to stop the bleeding. This treatment approach reduced the bleeding. Then, to promote clot formation and firmness, 2 g of fibrinogen and 1250 IU of factor XIII were administered, and the bleeding finally stopped. No further transfusions were required, and the patient was discharged from the hospital on day 10 after the operation. This case suggests that in clopidogrel-related bleeding refractory to conventional hemostatic therapy, hemostasis may be achieved by a stepwise administration of coagulation factor concentrates.
引用
收藏
页码:E39 / E41
页数:3
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