PS-R02-4: MANAGEMENT OF BLEEDING IN SEVERE TR AND MR WITH CAD UNDERGOING OPEN HEART SUGERY

Abstract

Raising ACT may be led to active bleeding. There are two scenarios On the other hand, after major causes, use the best treatment in the patient with a history of coagulopathy, and using anticoagulant drugs can typically prevent the same events. Raising ACT may be led to active bleeding. There are 2senarios 1. active bleeding similar to our case. 2. delayed tamponade because this bleeding summed and gathered and cause clotting formation and led to tamponade. On the other hand, after major causes, use the best treatment in the patient with a history of coagulopathy, and anticoagulant drugs can prevent the same events. Summary of the report This is about a specific 68 years old woman diagnosed with severe TR (tricuspid valve disease) and severe MR mitral valve regurgitation. After that, she underwent open-heart surgery, and subsequently, after three hours of needed surgery, she experienced drainage. Alternatively, she had transferred to the operations room, and the very first problem was that she had no dominant surgical site, while her ACT Active Clotting Time was 900. On the other hand, because the case had been treated with aspirin, after the operation, she received protamine; however, protamine, in these cases, shows the rebound feedback, and the complex interaction with the platelet is not successful and robust. For this apparent reason, when the ACT is about 130, one hour after the operation, ACT elevates to 900, and the patient experiences bleeding. Her sternum was kept open out of lacking any operation site. Standard treatment with FFP and Fibrinogen started, and after that, the patient general condition improved, and her sternum was closed the following day. It should be noted that the patient had a pandesal surgery history and also raised ACT history 16 years before the mentioned surgery.