Intravenous Infusion of Tranexamic Acid during Aortic Valve Replacement in a Patient with Indiopathic Thrombocytopenic Purpura / 日本心臓血管外科学会雑誌

ABSTRACT

An 82-year-old woman, who had suffered from idiopathic thrombocytopenic purpura (ITP) treated with oral steroids, was admitted to our hospital with worsening exertional dyspnea. Cardiac examinations revealed severe aortic stenosis with left ventricular dysfunction. High dose intravenous gammaglobulin therapy (400 mg/kg/day) for 5 days was conducted to increase the platelet count prior to the operation. However, a decrease was observed in the platelet count from 2.1×10⁴/mm³ on admission to 1.9×10⁴/mm³ before surgery. Without additional therapy, aortic valve replacement using a 19 mm bioprosthesis was performed with cardiopulmonary bypass (CPB). Tranexamic acid (20 mg/kg/h) was continuously infused from the skin incision to the end of the surgery. Forty units of the platelet concentrates were transfused just after weaning from CPB. The patient had no hemorrhagic complications. We believe that intraoperative administration of tranexamic acid combined with platelet transfusion is effective to reduce perioperative bleeding for a patient with ITP unresponsive to preoperative gammaglobulin therapy.