Abstract
A case of excessive heparin requirement during cardiopulmonary bypass is reported. A patient with sepsis secondary to a myocardial abscess required 13.5 mg . kg-1of heparin to increase his activated coagulation time to a therapeutic level. This phenomenon might be due to individual variability, lupus vasculitis, septicaemia, repeated thromboembolic phenomenon with hypercoagulable state, or chronic disseminated intravascular coagulation with partial antithrombin deficiency.
Résumé
Les auteurs rapportent le cas d’un malade ayant requis des doses très importantes d’héparine pour atteindre des niveaux thérapeutiques au cours d’une circulation extracorporelle. Ce patient hospitalisé en septicémie avec un abcès myocardique a subi une resection d’anévrysme ventriculaire avec résection de thrombi ventriculaires. On a dû administrer une dose totale d’héparine de 13.5 mk . kg-1 pour atteindre une héparinisation adéquate pour la circulation extra-corporelle.
On a retenu plusieurs facteurs pouvant expliquer le phénomène dans ce cas particulier à savoir: la possibilité d’une variation individuelle de la sensibilité à l’héparine, la présence d’une vasculite à lupus, l’état de septicémie du malade, les épisodes emboliques répétés (avec un état d’hypercoagulabilité) survenus chez ce patient ou, enfin une coagulation intravasculaire chronique avec activité antithrombique déficiente.
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Chung, F., David, T.E. & Watt, J. Excessive requirement for heparin during cardiac surgery. Canad. Anaesth. Soc. J. 28, 280–282 (1981). https://doi.org/10.1007/BF03005516
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DOI: https://doi.org/10.1007/BF03005516