KHÁNG HEPARIN DO THIẾU YẾU TỐ ANTI THROMBIN III TRONG PHẪU THUẬT TIM TRẺ EM CÓ SỬ DỤNG TUẦN HOÀN NGOÀI CƠ THỂ: BÁO CÁO CA LÂM SÀNG

Abstract

Overview: Heparin causes anti thrombin III to bind to coagulation factors, leading to inactivation of coagulation factors IIa, IXa, Xa, XIa and XIIa. This inhibition results in an anticoagulant effect. Bolus 300-400 IU/Kg heparin before performing extracorporeal circulation. ACT test is a method used to monitor the anticoagulant effect of heparin before performing extracorporeal circulation, and performing cardiopulmonary bypass when ACT reaches > 480s. Heparin resistance due to anti thrombin III deficiency is one of the main causes in cardiac surgery with cardiopulmonary bypass. This is a case that needs to be treated before performing cardiopulmonary bypass. We present a case of heparin resistance in the case of preparing for cardiopulmonary bypass. Case presentation: Male patient, born in 2021, weight 8.4 kg, diagnosed with transposition of the great arteries (D-TGV), sub pulmonary ventricular septal defect, bidirectional shunt, atrial septal defect, history of ductus arteriosus surgery, widening of the atrial septum, pulmonary artery stenosis, indication for transposition of the great arteries surgery, the patient was bolused 4 times with heparin with a total dose of 4100 IU (490 IU/kg), the highest measured ACT value was 250 seconds. Heparin resistance was diagnosed, so a quantitative AT-III test was performed, the result was 32.8% (normal value is 80-139), the patient was treated with fresh frozen plasma, transferred to intensive care, treated medically. Conclusion: Heparin resistance is a condition that requires treatment in cardiopulmonary bypass, so we give warnings when encountering heparin resistance and have given fresh frozen plasma but still do not reach the required ACT level. And we hope to have alternative anticoagulants in cardiopulmonary bypass such as Bivalirudin and some recommendations from clinical guidelines.