Use of the Hepcon/HMS-system for monitoring of heparinization during extracorporeal circulation is possible without increased risk of thromboembolism. Postoperative blood loss was slightly but significantly increased but there was no need for more heterogenous transfusion.
Bacterial growth in relation to suction drains and suction drain tubes following total hip replacements was studied in 105 consecutive patients. All the patients were operated on in a Charnley Howorth Mark II sterile enclosure without walls, but with a body exhaust system and routine antimicrobial prophylaxis. Specimens for culture were taken from the suction drain tip, from inside the suction tube and the incision site. Positive cultures were found in a7 patients; in 20 of them from either the drain tip or the drain track. In 15 patients, the culture revealed coa-gulase-negative staphylococci; in 12 of them from the drain tip or the drain track. Eight patients had a positive culture from the tip of the drain and 16 from the drain track. Four patients had signs of wound hematoma and serous discharge. No patient developed signs of deep infection during the first 12 months after surgery. This study confirms that coagulase-negative staphylococci are the most common single species obtained from cultures after total hip replacement. Routine antimicrobial prophylaxis against coagulase-negative staphylococci might be considered.
Heparin-induced thrombocytopenia (HIT) is a severe complication following the application of heparin; antibodies against complexes of heparin and PDF4 initiate activation of platelets. This may lead to massive thrombembolism, which is associated with a slight and transient drop of platelets in HIT I or a drop below 50% after approximately 5 days in HIT II. Further administration of heparin has to be strictly avoided in these patients. Immunologic evidence for HIT can easily be obtained by the heparin-induced platelet aggregation assay. If anticoagulation is necessary, different, alternative drugs are available. Recombinant hirudin (r-hirudin) is a well-established drug for safe anticoagulation. Monitoring is possible by estimating the plasma level of r-hirudin from the ecarin-clotting time. We report a case of a patient with prosthetic aortic valve endocarditis and HIT II who suffered from massive postoperative bleeding requiring massive substitution of blood components and coagulants caused by free circulating r-hirudin due to the use of a hemofilter.
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