Transcatheter aortic valve implantation under lower activated clotting time in a patient with hemorrhagic gastric cancer: a case report

Yuki Mitsuta; Takafumi Oyoshi; Takahiro Nonaka; Naoyuki Hirata

doi:10.1186/s40981-022-00566-9

Transcatheter aortic valve implantation under lower activated clotting time in a patient with hemorrhagic gastric cancer: a case report

JA Clin Rep. 2022 Oct 3;8(1):77. doi: 10.1186/s40981-022-00566-9.

Authors

Yuki Mitsuta¹, Takafumi Oyoshi¹, Takahiro Nonaka², Naoyuki Hirata³

Affiliations

¹ Department of Anesthesiology, Kumamoto University Hospital, Kumamoto, 860-8556, Japan.
² Department of Anesthesiology, Kumamoto City Hospital, Kumamoto, Japan.
³ Department of Anesthesiology, Kumamoto University Hospital, Kumamoto, 860-8556, Japan. naohirata@mac.com.

Abstract

Background: Perioperative management of transcatheter aortic valve implantation (TAVI) in patients with a high risk of bleeding requires careful consideration.

Case presentation: A 74-year-old man complained of chest pain and was admitted to our hospital. Close examination revealed severe aortic stenosis (AS) and hemorrhagic gastric cancer. Hemorrhage from gastric cancer was controlled using endoscopic hemostasis. While both gastric cancer and AS required surgery, we decided to perform transfemoral transcatheter aortic valve implantation (TAVI) under monitored anesthesia. To reduce bleeding from gastric cancer, we carefully adjusted the heparin dose to maintain the activated clotting time (ACT) between 180 and 200 s. TAVI with a balloon-expandable valve was completed without thrombotic complications. Laparoscopic distal gastrectomy was performed on the 6th day after TAVI.

Conclusions: We report the successful management of TAVI in a patient with hemorrhagic gastric cancer. In TAVI for patients with hemorrhagic diseases, careful consideration of antithrombotic therapy is required.

Keywords: Activated clotting time; Aortic stenosis; Transcatheter aortic valve implantation.