Aortic valve replacement in a patient with the prothrombin 20210A mutation.
Patients presenting for cardiac surgery with hypercoagulable states pose a challenge. Although preoperative functional and genetic screening for hypercoagulable disorders may provide pathophysiologic information, it is difficult to make preoperative hematologic management plans in the absence of consensus guidelines, prospective studies, or case reports. We document the first case of prothrombin 20210A mutation in a patient undergoing elective aortic valve replacement. Peri-procedural bridging with heparin and avoidance of antifibrinolytic agents represent salient features of our successful perioperative management.
Galvagno
Samuel M
SM
Department of Anesthesiology, Perioperative and Pain Medicine, Division of Cardiac Surgery, Brigham and Woman's Hospital, Boston, Massachusetts 02115, USA.
Bean
Teresa M
TM
McAdams
Michael
M
D'Ambra
Michael N
MN
D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D009154:Mutation; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011516:Prothrombin / Q000235:genetics*; D018570:Risk Assessment; D013923:Thromboembolism / Q000150:complications / Q000188:drug therapy / Q000235:genetics*; D016896:Treatment Outcome
D011516:Prothrombin; D006493:Heparin