Thrombosis after hypothermic circulatory arrest for cardiovascular surgery, antifibrinolytic drugs, and thrombophilia.

摘要

To the Editor:-We read with great interest the report of Shore-Lesserson and Reich regarding a fatal case of venous thromboembo-Iism during cardiac surgery with hypothermic circulator) arrest associated with the use of aprotirrin in a patient diagnosed, with postmortem analysis, as a carrier of factor V Leiden. The same authors had previously described two fatal cases of intraoperative thrombosis in patients undergoing the same surgical procedure and treated with s-aminocaproic acid: One of the two patients was a postmortem-diagnosed carrier of the factor V Leiden mutation. Because of the occurrence over a 3-yr period of four fatal thrombotic events in cardiovascular patients operated on with hypothermic circulatory arrest and treated with antifibrinolytic drugs, the authors of these reports are now screening for the factor V Leiden mutation all patients scheduled to undergo elective surgical procedures requiring hypothermic circulatory arrest to avoid the use of antifibrinolytic drugs in patients who are carriers of the mutation.