A Case Report of Anesthesia for Abdominal Aortic Aneurysm of a Patient with Essential Thrombocythemia

Abstract

  We report a case of heparin resistance caused by thrombocytosis. A 75-year-old man with complicated essential thrombocythemia was scheduled for vascular prosthesis replacement for the abdominal aortic aneurysm. 10,000 units of heparin was administered but resulted a top-short activated coagulation time (ACT) . Alternatively, argatroban was administered to maintain anticoagulant activity. Remarkable increase of platelet factor 4 (PF4) in essential thrombocythemia is often observed, and large quantity of PF4 was released by heparin administration. PF4 is a substance that neutralizes heparin. As a result, activity of heparin became ineffective. It was considered that argatroban is a useful anticoagulant for patients with essential thrombocythemia.