Off-Pump Coronary Artery Bypass Grafting With Nafamostat in a Patient With Kasabach-Merritt Syndrome: A Case Report

Heparin is used as an anticoagulant in coronary artery bypass grafting (CABG), but in conditions where heparin is contraindicated, an alternative anticoagulant is required. Kasabach-Merritt syndrome is characterized by thrombocytopenia and consumption coagulopathy associated with kaposiform hemangioendothelioma (KHE) and tufted angioma (TA). There is no consensus regarding intraoperative anticoagulation in patients with Kasabach-Merritt syndrome undergoing CABG. A man in his 70s with angina pectoris and lesions in the left main trunk (LMT) was scheduled for CAGB. He was diagnosed with Kasabach-Merritt syndrome as a child and had consumptive coagulopathy. There were concerns that using cardiopulmonary bypass and an antithrombin agent as an alternative anticoagulant might increase the risk of bleeding. Surgery was performed using an off-pump CABG (OPCAB) without heparin, and nafamostat was administered as an alternative anticoagulant at a bolus dose and continuously. The surgery was completed without thrombus formation or other adverse events, and the postoperative course was generally good. The graft was confirmed to be patent, and the patient was discharged on day 24. Nafamostat was thus found to be an effective intraoperative anticoagulant in a patient with Kasabach-Merritt syndrome. OPCAB with nafamostat represents a viable treatment option when heparin is contraindicated, but further studies are needed to clarify optimal intraoperative anticoagulation strategies.