Hiperfibrinolizis; Kardiopulmoner Bypass Sonrası Gelişen Ciddi ve Mortal Bir Komplikasyon: Olgu Sunumu

Abstract

Kanama, kardiyopulmoner bypass (CPB) kullanılarak yapılan kalp cerrahisinin en önemli komplikasyonlarından biridir. Her türlü tıbbi ve cerrahi tedaviye rağmen baypas sonrası kanama hala ciddi bir problemdir. Ağır travmada olduğu gibi hipotermi, asidoz, hipovolemi, hipoperfüzyon nedeni ile CPB da pıhtılaşma sürecinin bozulmasına neden olur. Majör travma ve majör cerrahi sonrasında gelişebilen Hiperfibrinoliz (HF), yaşamı tehdit eden ciddi kanama bozukluğuna sebep olabilir. Kalp cerrahisi sonrası HF görülme sıklığı % 15 ile % 20 arasında tahmin edilmektedir. HF tanısında altın standart trombelastografi veya trombelastometridir. Hiperfibrinoliz tedavisinde kan ürünleri ve traneksemik asit kullanılır. HFtedavisinde traneksemik aside alternatif olarak kullanılabilen ajanlar aprotinin ve epsilon aminokaproik asittir. Kalp cerrahisi sonrası gelişen kanama problemlerinde HF tanısı gözden kaçabilir. Bu nedenle erken teşhis ve tedavinin hayat kurtarıcı olduğu bu nadirpatolojiyi paylaşmak istedik.

Keywords

• Hiperfibrinoliz
• koroner bypass
• kanama

Hyperfibrinolysis; A Serious and Mortal Complication After Cardiopulmonary Bypasses: Case Report

Abstract

Hemorrhage is one of the major complications of cardiac surgery when using cardiopulmonary bypass (CPB). Despite all kinds of medical and surgical treatment, post bypass bleeding is still a serious problem. Hypothermia, acidosis, hypovolemia, and hypoperfusion lead to disruption of the coagulation process in severe trauma as well as in CPB. Hyperfibrinolysis (HF) is a life-threatening bleeding disorder in major trauma patients. The incidence of HF has been estimated in the range of 15% to 20%. The gold standard for the detection of HF is thrombelastography or thromboelastometry. Blood products and tranexamic acid are used in the treatment of hyperfibrinolysis. The agents that can be used as an alternative to tranexamic acid in HF treatment are aprotinin and epsilon aminocaproic acid. Early diagnosis and treatment of HF are life-saving. For this purpose, we wanted to share this rare pathology.

Keywords

• hyperfibrinolysis
• cardiopulmonary bypass
• hemorrhage

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