The American journal of case reports
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BACKGROUND Cardiac vasoplegic syndrome is a form of vasodilatory shock characterized by profound vasodilation and low systemic vascular resistance, which results in significant hypotension despite high cardiac output and appropriate fluid resuscitation. In up to 45% of patients, cardiopulmonary bypass (CPB) can precipitate vasoplegic syndrome. Vasoplegic syndrome after CPB that is refractory to other vasopressors, such as catecholamine and vasopressin, has been successfully treated with inhibitors of the nitric oxide (NO) system, such as methylene blue and hydroxocobalamin. ⋯ Specifically, we demonstrate the appropriate and successful use of hydroxocobalamin alone to treat refractory vasoplegic syndrome after CPB. CONCLUSIONS Refractory vasoplegic syndrome that occurs after CPB has been successfully treated with inhibitors of the NO system, such as methylene blue and hydroxocobalamin. The present cases expand upon the scant existing evidence of the efficacy of hydroxocobalamin as an appropriate option for refractory vasoplegic syndrome.
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BACKGROUND The COVID-19 pandemic is an ongoing cause of the current global healthcare crisis. Several vaccines were approved for use by emergency vaccination campaigns worldwide. At present, there are very few reports of COVID-19 vaccine-induced immune-thrombotic thrombocytopenia, a variant of heparin-induced thrombocytopenia (HIT), in comparison to the massive number of vaccinated people worldwide. ⋯ She was hospitalized for 4 days and discharged home with an oral anticoagulant (rivaroxaban). CONCLUSIONS This case report describes a possible link between BNT162b2 mRNA COVID-19 (Pfizer-BioNTech) vaccination and thromboembolism. However, further data are needed to support such an association.