Heparin

Abstract

Intrapulmonary haemorrhage: case report In case series, a 38‑year‑old woman was described, who developed intrapulmonary haemorrhage following anticoagulation therapy with heparin [route and dosage not stated]. The woman, who had chronic thromboembolic pulmonary hypertension, underwent examination and scheduled for pulmonary endarterectomy (PET). PET was carried out under cardiopulmonary bypass. She also had deep hypothermic circulatory arrest. She had been receiving anticoagulation therapy with heparin. However, she had bleeding from an endotracheal tube and a bronchoscopy demonstrated haemorrhage in her right intermedius bronchus. Thus, mechanical ventilation was provided. But, the ventilation had failed due to severe intrapulmonary haemorrhage and she required central veno‑arterial extracorporeal membrane oxygenation due to haemodynamic instability. An anaesthesia was performed with isoflurane, fentanyl and atracuriumbesilate [atracurium] infusion. It was considered that the intrapulmonary haemorrhage was secondary to anticoagulation therapy with heparin [duration of treatment to reaction onset not stated]. Therefore, the woman treated with protamine sulfate that led to partial reversal of anticoagulation and her activated coagulation time (ACT) remained between 160 and 180 seconds. Her pulmonary angiography showed possible bleeding from bronchial artery and her right internal mammary collaterals. Thus, coil-embolisation was carried out that led to resolution of the bleeding. On postoperative day 2, she had improvement in her cardiac function and her bronchoscopy showed clots on the fourth day after the operation. on post-operative day 8, the extracorporeal membrane oxygenation was removed and she had uneventful recovery thereafter that led to discharge from the hospital.