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

Yıl 2021, , 319 - 322, 01.11.2021

Zeki Talas , Burhan Küçük Muhip Kanko , Tülay Çardaközü , Özgür Mehtap

https://doi.org/10.30934/kusbed.833647

Öz

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.

Anahtar Kelimeler

Hiperfibrinoliz, koroner bypass, kanama

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

Öz

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.

Anahtar Kelimeler

hyperfibrinolysis, cardiopulmonary bypass, hemorrhage

Kaynakça

• Kuepper F, Dangas G, Mueller-Chorus A, Kulka PM, Zenz M, Wiebalck A. Fibrinolytic Activity and Bleeding After Cardiac Surgery With Cardiopulmonary Bypass and Low-Dose Aprotinin Therapy. Clinical Trial Blood Coagul Fibrinolysis. 2003 Feb;14(2):147-53. doi: 10.1097/00001721-200302000-00005.
• Schöchl H, Thomas F, Michaela P, Csilla J. Hyperfibrinolysis After Major Trauma: Differential Diagnosis of Lysis Patterns and Prognostic Value of Thrombelastometry. The Journal of Trauma: Injury, Infection, and Critical Care: July 2009 - Volume 67 - Issue 1 - p 125-131 doi: 10.1097/TA.0b013e31818b2483
• Schöchl H, Voelckel W, Maegele M, Solomon C. Trauma-associated Hyperfibrinolysis. Hamostaseologie. 2012;32(1):22-7. doi: 10.5482/ha-1178
• Kapsch DN, Metzler M, Harrington M, Mitchell FL, Silver D. Fibrino-lytic response to trauma. Surgery. 1984;95:473– 478
• Luddington RJ. Thromboelastography/thromboelastometry. Clin Lab Haematol. 2005;27:81–90
• Spiel AO, Mayr FB, Firbas C, Quehenberger P, Jilma B. Validation of rotation thrombelastography in a model of systemic activation of fibrinoly-sis and coagulation in humans. J Thromb Haemost. 2006;4:411– 416
• Lewis S. Gall, Karim Brohi, Ross A. Davenport. Diagnosis and Treatment of Hyperfibrinolysis in Trauma (A European Perspective). Semin Thromb Hemost 2017; 43(2): 224-234. DOI: 10.1055/s-0036-1598001
• Levrat A., Gros A., Rugeri L., Inaba K., Floccard B., Negrier C., David JS et al. Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. BJA: British Journal of Anaesthesia, Volume 100, Issue 6, June 2008, Pages 792–797, https://doi.org/10.1093/bja/aen083
• Türk hematoloji derneği - temel hemostaz tromboz kursu. https://www.thd.org.tr/thdData/userfiles/file/2007thtk_03.pdf. Koagülasyon testleri ve klinik kullanımı. 8 Eylül 2007 erişildi.
• 1Shakur H, Roberts I, Bautista R, et al; CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376 (9734): 23-32
• Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. Br Med J 2012; 344: e3054
• Fergusson DA, Hébert PC, Mazer CD, et al; BART Investigators. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008; 358 (22) 2319-2331