2022 Volume 26 Issue 1 Pages 65-69
Perioperative bleeding control is particularly important in patients with idiopathic thrombocytopenic purpura undergoing cardiac and major vascular surgery. In this case, the patient was started on 10 mg prednisolone and 12.5 mg eltrombopag 6 weeks before surgery. As the platelet count increased from 28,000/μl to 127,000/μl, preoperative gamma globulin therapy or platelet transfusion was not performed. In order to avoid extracorporeal circulation, she underwent off-pump coronary artery bypass grafting. Intraoperative hemostasis was achieved by transfusion of 20 units of concentrated platelets. However, postoperative graft occlusion occurred. The present case suggests that thrombopoietin receptor agonists can effectively increase platelet counts in patients with idiopathic thrombocytopenic purpura undergoing coronary artery bypass surgery, but their use should be considered with caution because of possible thrombotic complications.
