2023 Volume 27 Issue 1 Pages 73-78
We performed cardiac surgery involving the use of an artificial heart lung apparatus with argatroban and nafamostat mesylate in patients who were positive for HIT antibodies (platelet factor 4-heparin conjugate antibodies). Following a sternotomy, the intravenous administration of 0.2 mg/kg and continuous administration of 10 μg/kg/min of argatroban was initiated, with the continuous administration of 120 mg/hr of nafamostat mesylate used from the start of using the artificial heart lung apparatus. Argatroban was increased so that the activation coagulation time (ACT) would be 400 seconds or more; however, a blood clot occurred in the artificial heart lung apparatus and intraoperative autotransfusion system circuits. In addition, the administration of argatroban 30 minutes prior to the end of using the artificial heart lung apparatus and nafamostat mesylate was completed after stopping to use the artificial heart lung apparatus; however, it became difficult to stop the bleeding after withdrawing the artificial heart lung apparatus, so a large blood transfusion was required. ACT recovery was observed 6 hours following the withdrawal of the artificial heart lung apparatus.
When using argatroban and nafamostat mesylate to prevent hemostasis following the detachment of an artificial heart lung apparatus, it is important to properly determine the start time of the artificial heart lung apparatus and adjust the drugs by using multiple ACT measuring instruments with different activators. However, the dosage and timing of the start of administration remain controversial, so it is necessary to accumulate more cases going forward.
