Peri-operative management of an adult patient with type 2N von Willebrand's disease scheduled for coronary artery bypass graft.
We describe a patient with type 2N von Willebrand's disease scheduled for elective coronary artery bypass graft for severe three-vessel coronary artery disease with involvement of the left main stem. He was given a pre-operative bolus of 3000 IU factor VIII/Willebrand factor concentrate (approximately 40 IU.kg(-1)), followed by a continuous infusion of 3 IU.h(-1) (228 IU.h(-1)) before undergoing coronary surgery with full heparinisation and cardiopulmonary bypass. There were no intra-operative bleeding complications and only one unit of packed red blood cells was required postoperatively. Thromboprophylaxis with low-molecular weight heparin and aspirin was given and the infusion of factor VIII/von Willebrand factor concentrate continued for 2 days. As a result of haematological monitoring, heparin therapy was changed from prophylactic to therapeutic on day 5-6 and stopped on day 7.
Gerling
V
V
Department of Cardiothoracic Anaesthesia, University Medical Center, Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. V.Gerlingumcutrecht.nl
Lahpor
J R
JR
Buhre
W
W
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000379:methods*; D005169:Factor VIII / Q000627:therapeutic use; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D014842:von Willebrand Diseases / Q000150:complications* / Q000188:drug therapy; D014841:von Willebrand Factor / Q000627:therapeutic use
D000925:Anticoagulants; D014841:von Willebrand Factor; D005169:Factor VIII