Prothrombin Complex Concentrate for Rapid Preoperative Reversal of Warfarin-Related Coagulopatby in Patients with Diffuse Peritonitis: Two Cases Report

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  • ワーファリン内服中の腹膜炎緊急手術時に乾燥人血液凝固第ＩＸ因子複合体を術前投与した２例

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Emergency surgeries were conducted with the aid of a mixed type coagulation factor preparation on 2 patients who developed peritonitis while under oral medication with warfarin. The first case, an 80-year-male, had been treated with 2mg/day of oral warfarin following aortic valvoplasty and prosthetic vascular replacement. He underwent surgery for perforating appendicitis and peritoneal abscess. Prior to the surgical procedure, his PT (INR) was 4.69 and Thrombotest, below 5%. The second case, an 89-year-old woman, had been treated with 1.5mg/day of oral warfarin for atrial fibrillation. She underwent surgery with a diagnosis of strangulating ileus. Her preoperative PT (INR) was 2.73 and Thrombotest, 5.2%. To these two patients, 500E of a prothrombin complex concentrates (PCC) was administered prior to surgery. The coagulation test that was conducted on these patients 15 minutes after this treatment showed a marked shortening in the coagulation time in the PT (INR) and Thrombotest. Their pen-operative courses were uneventful, without hemorrhagic tendencies or complications. The use of a mixed coagulation factor preparation is not included in the current coverage under our National Health Insurance Policy when it is applied to patients who had been receiving warfarin and undergoing emergency surgery. However, the efficacy of the preparation was indicated in these cases. An evaluation is needed to see if the current coverage under this insurance policy should be extended to include this modification.

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