Intravenous Infusion of Tranexamic Acid during Aortic Valve Replacement in a Patient with Indiopathic Thrombocytopenic Purpura

(Department of Cardiovascular Surgery, JA Onomichi Genaral Hospital, Onomichi, Japan)

Masaki Hamamoto Daisuke Futagami
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(400mg/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 19mm bioprosthesis was performed with cardiopulmonary bypass(CPB). Tranexamic acid(20mg/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.
  Jpn. J. Cardiovasc. Surg. 41:99-102(2012)

Keywords:idiopathic thrombocytopenic purpura, aortic valve replacement, tranexamic acid, high-dose intravenous gammaglobulin therapy