Can procoagulant use lead to hypercoagulable state? A case of intravascular and intracardiac thrombosis after protamine administration

Abstract

Antifibrinolytics e.g. tranexamic acid (TA) are frequently used during cardiac surgical procedures on cardiopulmonary bypass for supporting hemostasis and reducing blood transfusion requirement. A 42 years old lady with chronic atrial fibrillation (AF), severe mitral regurgitation (MR) and tricuspid regurgitation (TR) underwent mitral valve replacement (MVR) and tricuspid valve (TV) repair. The anesthetic and surgical management was uneventful but soon after the reversal of heparin with protamine, the patient developed intracardiac and intra-arterial thrombosis extending to abdominal aorta. The patient received TA bolus at induction followed by infusion during the cardiopulmonary bypass. The safety of routine prophylactic use of antifibrinolytic was questioned and routine use of screening tools e.g. thromboelastometry suggested.
Citation: Abu Zaid AD, Malik MA, Alhossan AA. Can procoagulant use lead to hypercoagulable state? A case of intravascular and intracardiac thrombosis after protamine administration. Anaesth Pain & Intensive Care 2018;22(4):­­518-521
Received: 27 Sep 2018, Reviewed: 16 Oct, 30 Oct 2018, Accepted: 6 Dec 2018