トロンボエラストグラフィを用いた血友病A患者に対する冠状動脈バイパス術の1例

Coronary Artery Bypass Grafting in a Patient with Hemophilia A Assisted by Thromboelastography：Report of a Case

はじめに　血友病Aに罹患した心筋梗塞の患者に対する冠状動脈バイパス術を経験した．当院では2020年にトロンボエラストグラフィ（thromboelastgraphy：TEG，Haemonetics社）を導入し，手術時の凝固因子の変化を評価している．血友病患者の開心術時に第Ⅷ因子と活性化部分トロンボプラスチン時間（activated partial thromboplastin time：APTT）の測定に加え，TEGを用いた報告はほとんどない．有効活用の周知のため報告する．

We report a case of coronary artery bypass grafting using thromboelastography in a 42-year-old male patient with hemophilia A. He was diagnosed with hemophilia A at the age of three years old, and was also infected with hepatitis C and human immunodeficiency virus （HIV）. He complained of chest pain at home and was brought to our institute and diagnosed with acute myocardial infarction. Concerned about the risk of bleeding, coronary artery bypass grafting was selected to avoid permanent administration of antiplatelet agents. Although there were concerns about bleeding caused by various coagulation factor abnormalities due to the use of cardiopulmonary bypass, we could accurately assess the coagulation factors by using thromboelastography and replenishing them in appropriate amounts. The operation was performed safely as usual and successfully finished.