An infrequent complication of a not so infrequent disease. Hit by HIT

Asian Cardiovasc Thorac Ann. 2019 Feb;27(2):124-126. doi: 10.1177/0218492318791076. Epub 2018 Jul 16.

Abstract

Heparin-induced thrombocytopenia is not uncommon in cardiac surgery. Thrombosis is the most frequent complication. A 77-year-old man suffered cardiac arrest due to right coronary emboli. Transesophageal echocardiography revealed tissue valve thrombosis. He required support with an extracorporeal membrane oxygenator that also thrombosed. Heparin-induced thrombocytopenia was diagnosed, and anticoagulation was switched to argatroban. Heparin- induced thrombocytopenia normally presents as vascular thrombosis. In this case, the first symptom was tissue valve thrombosis causing an acute coronary syndrome. It is not an uncommon complication and should be considered if unexpected thrombosis and a sudden drop in platelet count develops after heparin exposure.

Keywords: Antibodies; Argatroban; Bioprosthesis; Heparin; Platelet factor 4; Thrombocytopenia.

Publication types

  • Case Reports

MeSH terms

  • Acute Coronary Syndrome / chemically induced*
  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / therapy
  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects*
  • Antithrombins / administration & dosage
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Arginine / analogs & derivatives
  • Drug Substitution
  • Echocardiography, Transesophageal
  • Electrocardiography
  • Extracorporeal Membrane Oxygenation / adverse effects
  • Fatal Outcome
  • Heart Arrest / chemically induced*
  • Heart Arrest / diagnosis
  • Heart Arrest / therapy
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heparin / adverse effects*
  • Humans
  • Male
  • Pipecolic Acids / administration & dosage
  • Sulfonamides
  • Thrombectomy
  • Thrombocytopenia / chemically induced*
  • Thrombocytopenia / diagnosis
  • Thrombocytopenia / therapy
  • Thrombosis / diagnostic imaging
  • Thrombosis / etiology*
  • Thrombosis / therapy
  • Treatment Outcome

Substances

  • Anticoagulants
  • Antithrombins
  • Pipecolic Acids
  • Sulfonamides
  • Heparin
  • Arginine
  • argatroban