Surgeries for the Heart and Abdominal Aorta in a Patient with Heparin-Induced Thrombocytopenia: Manifestations Following Initial Heart Surgery

Abstract

A 72-year-old man with abdominal aortic aneurysm and angina pectoris underwent coronary artery bypass grafting (CABG) prior to abdominal aortic surgery. Perioperatively, he developed thrombocytopenia ((29,000 mm3), which was suggested as heparin-induced thrombocytopenia. Cardiac status was also aggravated at the same time, suggestive of bypass graft thrombosis. The results of platelet factor 4 (pf4) antibody test were negative, but platelet aggregation test was positive for heparin. Heparin was immediately discontinued, and replaced by argatroban; the patient’s cardiac status improved. One month later, he underwent abdominal aortic surgery using argatroban without issues related to anticoagulation and hemostasis. Autologous donated fresh blood prepared by the “switch-back” method was also used in this case, and its value was confirmed.