REDO CARDIAC-SURGERY - LATE BLEEDING COMPLICATIONS FROM TOPICAL THROMBIN-INDUCED FACTOR-V DEFICIENCY

被引:81
作者
CMOLIK, BL
SPERO, JA
MAGOVERN, GJ
CLARK, RE
REID, C
EDMUNDS, LH
TYERS, GFO
CMOLIK
ROSE, E
机构
[1] MED COLL PENN,ALLEGHENY SINGER RES INST,CARDIOVASC & PULM RES CTR,PHILADELPHIA,PA 19129
[2] ALLEGHENY GEN HOSP,DEPT SURG,PITTSBURGH,PA 15212
[3] ALLEGHENY GEN HOSP,DEPT MED,PITTSBURGH,PA 15212
关键词
D O I
10.1016/S0022-5223(19)33804-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Bovine thrombin-induced factor V deficiency was thought to be a very rare acquired coagulopathy, with only three documented cases. We report a series of nine patients seen during a period of 32 months; these patients had normal preoperative coagulation profiles, and this unique coagulopathy developed 1 to 2 weeks after cardiovascular operations. The coagulopathy was characterized by a markedly elevated prothrombin time (40.9 +/- 5.8 seconds), an elevated activated partial thromboplastin time (96.3 +/- 12.2 seconds), a study positive for lupus anticoagulation (9/9), and markedly decreased levels of factor V (0.09 +/- 0.03 U/ml) and factor XI (0.04 +/- 0.02 U/ml), respectively. All patients had been exposed to commercially available bovine thrombin during prior cardiovascular or vascular operations and received a second bovine thrombin challenge during the latest procedure. Coagulopathic bleeding developed in four of the nine patients. Bleeding was unrelated to absolute fall in factor V level, but cessation of hemorrhage appeared to correlate with improvement in factor V level. Treatment with vitamin K, fresh frozen plasma, and platelet infusion were all unsuccessful in altering prothrombin time or factor V levels. Intravenous gamma globulin was used in three patients, two of whom were bleeding. All three patients showed a transient increase in factor V levels. Bleeding stopped in one of the two patients; the other continued to bleed and subsequently died. The third patient was treated prophylactically to increase factor V levels in preparation for flap reconstruction of his sternum. His factor V level increased from 0.26 to 0.49 U/ml, and he underwent the procedure without incident. Bovine thrombin-induced factor V deficiency may have been previously unrecognized. This deficiency should be suspected in patients who have undergone redo cardiovascular operations and in whom marked elevations in their prothrombin time occur 7 to 10 days after exposure to bovine thrombin. The resulting coagulopathy, although usually self-limited, has the potential to produce devastating bleeding complications. Intravenous gamma globulin (1 gm/kg during each of 2 days) has been used to increase factor V levels transiently but its role in therapy of this coagulopathy requires further investigation.
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页码:222 / 228
页数:7
相关论文
共 17 条
  • [1] ALIAGA JL, 1990, EUR RESPIR J, V3, P109
  • [2] CHEDIAK J, 1980, BLOOD, V56, P835
  • [3] FEINSTEIN DI, 1978, THROMB HAEMOSTASIS, V39, P663
  • [4] IATROGENIC IMMUNIZATION WITH BOVINE THROMBIN - A MECHANISM FOR PROLONGED THROMBIN TIMES AFTER SURGERY
    FLAHERTY, MJ
    HENDERSON, R
    WENER, MH
    [J]. ANNALS OF INTERNAL MEDICINE, 1989, 111 (08) : 631 - 634
  • [5] BLEEDING DUE TO AN ACQUIRED INHIBITOR OF PLATELET ASSOCIATED FACTOR-V
    GRIGG, AP
    DAUER, R
    THURLOW, PJ
    [J]. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE, 1989, 19 (04): : 310 - 314
  • [6] HARKER LA, 1980, BLOOD, V56, P824
  • [7] ISOLATION AND STUDY OF AN ACQUIRED INHIBITOR OF HUMAN COAGULATION FACTOR-V
    NESHEIM, ME
    NICHOLS, WL
    COLE, TL
    HOUSTON, JG
    SCHENK, RB
    MANN, KG
    BOWIE, EJW
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1986, 77 (02) : 405 - 415
  • [8] NICHOLS WL, 1991, BLOOD S10, V78, P241
  • [9] CLINICAL-SIGNIFICANCE OF ANTIBODIES TO BOVINE AND HUMAN THROMBIN AND FACTOR-V AFTER SURGICAL USE OF BOVINE THROMBIN
    RAPAPORT, SI
    ZIVELIN, A
    MINOW, RA
    HUNTER, CS
    DONNELLY, K
    [J]. AMERICAN JOURNAL OF CLINICAL PATHOLOGY, 1992, 97 (01) : 84 - 91
  • [10] SHAPIRO S S, 1975, Seminars in Thrombosis and Hemostasis, V1, P336