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Off-pump myocardial revascularization in a high-risk patient with essential thrombocythemia

Ahmad K Darwazah, Hamad Madi, Rami Zagha

    Texas Heart Institute Journal
    |November 27, 2014
    PubMed

    Insights

    Essential thrombocythemia patients with high platelet counts can safely undergo off-pump surgery. Pre-operative reduction of platelet count with hydroxycarbamide is crucial for successful outcomes.

    Area of Science:

    • Cardiology
    • Hematology
    • Oncology

    Background:

    • Essential thrombocythemia is a myeloproliferative disorder associated with frequent thrombotic complications.
    • Patients with essential thrombocythemia often present with comorbidities like coronary artery disease.

    Observation:

    • A 71-year-old male with severe coronary artery disease, cerebral ischemia, and erythromelalgia had a platelet count of 1,486 ×10(3)/μL.
    • The patient underwent successful off-pump myocardial revascularization after platelet count reduction with hydroxycarbamide.

    Findings:

    • Off-pump cardiopulmonary bypass is a safe surgical option for high-risk essential thrombocythemia patients.
    • Pre-operative platelet count reduction using hydroxycarbamide is vital for surgical success.

    Implications:

    • This case highlights a safe anesthetic and surgical approach for essential thrombocythemia patients undergoing cardiac surgery.
    • Careful management of antiplatelet and anticoagulant therapies is critical for optimizing surgical outcomes in these patients.

    Keywords:
    Blood platelets/metabolismJanus kinase 2coronary artery bypass, off-pumpgraft survivalhydroxycarbamidemega-karyocytesplatelet countplateletpheresisthrombocythemia, essential/blood/drug therapytreatment outcomevascular patency

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