Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Thrombolytic Therapy for Repeated Prosthetic Valvular Thrombosis That's Associated with Pregnancy under Heparin Anticoagulation

임신과 연관된 헤파린 항응고요법 중 반복적으로 발생한 인공판막 혈전증의 혈전용해치료

  • Choe, Ju-Won (Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Yongsan Hospital, Chung-Ang University College of Medicine) ;
  • Kim, Yong-In L. (Department of Thoracic and Cardiovascular Surgery, Seoul Paik Hospital, Inje University College of Medicine)
  • 최주원 (중앙대학교 의과대학 용산병원 흉부외과학교실) ;
  • 김용인 (인제대학교 의과대학 서울백병원 흉부외과학교실)
  • Published : 2008.08.05
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Abstract

During long-term anticoagulation treatment with using heparin in a pregnant patient with a mechanical mitral prosthesis, we observed several anticoagulation-related complications, including repeated prosthetic valve thrombosis. This was found to be caused by heparin resistance due to an anti-thrombin III deficiency. Thrombolytic therapy using urokinase or tissue plasminogen activator (tPA) was successful and safe for her as well as her baby.

기계판막을 이용한 승모판치환술을 시행 받은 환자가 임신과 연관되어 장기간의 헤파린 피하주사를 이용한 항응고 치료를 받는 중에, 반복적인 인공판막 혈전증을 포함하는 항응고제로 인한 다양한 합병증이 관찰되었다. 이는 안티트롬빈 III의 결핍으로 인한 헤파린 저항성에 의한 것으로 판단되었고, 유로키나아제 또는 조직플라즈미노겐활성제(tissue plasminogen activator, tPA)를 이용한 혈전용해치료를 통하여 산모와 태아 모두 안전하게 치료할 수 있었다.

Keywords

References

  1. Elkayam UR. Anticoagulation in pregnant women with prosthetic heart valves: a double jeopardy. J Am Coll Cardiol 1996;27:1698-703. https://doi.org/10.1016/0735-1097(96)00072-1
  2. Vitale N, De Feo M, De Santo LS, Pollice A, Tedesco N, Contrufo M. Dose-dependant fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol 1999;33:1637-41. https://doi.org/10.1016/S0735-1097(99)00044-3
  3. Nassar AH, Hobeika EM, Essamad HM, et al. Pregnancy outcome in women with prosthetic heart valve. Am J Obstet Gynecol 2004;191:1009-13. https://doi.org/10.1016/j.ajog.2004.05.064
  4. Bonow RO, Carabello B, de Leon AC, et al. Guidelines for the management of patients with valvular heart disease: excecutive summary. A report of the American college of Cardiology/American heart association task force on practice guidelines (committee on management of patients with valvular heart disease). Circulation 1998;98:1949-84. https://doi.org/10.1161/01.CIR.98.18.1949
  5. Ensom MH, Stephenson MD. Low-molecular-weight heparins in preganacy. Pharmacotherapy 1999;19:1013-25. https://doi.org/10.1592/phco.19.13.1013.31588
  6. Anderson JAM, Saenko EL. Heparin resistance. Br J Anaesth 2002;88:467-9. https://doi.org/10.1093/bja/88.4.467
  7. Lee GR, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM. Chapter 70 Thrombosis and antithrombotic therapy. In: Rodgers GM. Wintrobe's clinical hematology. 10th ed. Maryland: Williams & Wilkins. 1999;1781-818.
  8. Marniniak E, Gockerman JP. Heparin-induced decrease in circulating antithrombin III. Lancet 1977;2:581-4. https://doi.org/10.1016/S0140-6736(77)91429-5
  9. Avidan MS, Levy JH, Aken HV, et al. Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass. J Thorac Cardiovasc Surg 2005;130:107-13. https://doi.org/10.1016/j.jtcvs.2004.10.045
  10. Alpert JS. The thrombosed prosthetic valve. J Am Coll Cardiol 2003;41:659-60. https://doi.org/10.1016/S0735-1097(02)02871-1
  11. Lengyel M, Horstkotte D, Völler H, Mistiaen WP. Recommendations for management of prosthetic valve thrombosis. J heart Valve Dis 2005;14:567-75.
  12. Roudaut R, Lafitte S, Roudaut MF. Fibrinolysis of mechanical prosthetic valve throbosis. J Am Coll Cariol 2003;41:553-8.
  13. Leonhardt G, Gaul C, Nietsch HH, Buerke M, Schleussner E. Thrombolytic therapy in pregnancy. J Thromb Thrombolysis 2006;21:271-6. https://doi.org/10.1007/s11239-006-5709-z