2026 Volume 55 Issue 1 Pages 26-30
In cases complicated with immune thrombocytopenic purpura (ITP), the perioperative period in which cardiopulmonary bypass is used may pose a problem due to a rapid decrease in platelet count. In this case, we performed myxoma resection and a Maze procedure on a patient with a left atrial myxoma and atrial fibrillation who was receiving eltrombopag therapy under an ITP diagnosis. Initially, because the cardiology department suspected a left atrial thrombus caused by atrial fibrillation, eltrombopag administration was discontinued and anticoagulation therapy initiated; however, an episode occurred in which the platelet count precipitously fell from 192,000/μl to 71,000/μl over six days. Therefore, a plan was devised preoperatively to ensure stable continuation of ITP treatment, which involved administering a high-dose infusion of intravenous immunoglobulin (IVIG) preoperatively and using subcutaneous injection of romiplostim on the day of surgery. Due to the potential for excessive platelet elevation depending on the timing of eltrombopag reinitiation, the drug was restarted and adjusted at the point when a postoperative decline in platelet count was observed. The operation and postoperative course proceeded with good control and without significant bleeding. Although the patient had a history of sick sinus syndrome noted during preoperative internal medicine admission, postoperative bradycardia persisted; as a result, the patient underwent pacemaker implantation on postoperative day 23. The patient was unaffectedly discharged on postoperative day 34.
