28 May 2019
: Case report
Missed Heparin-Induced Thrombocytopenia (HIT) Diagnosis in a Patient with Acute Stent Thrombosis
Unusual clinical course, Mistake in diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Adverse events of drug therapy , Educational Purpose (only if useful for a systematic review or synthesis)
Vassilis Voudris1BE, Panagiota Georgiadou1E*, Panagiotis Kalogris2B, Theodora Kostelidou3D, Andreas Karabinis4D, Grigorios Gerotziafas56DDOI: 10.12659/AJCR.914988
Am J Case Rep 2019; 20:753-757
Abstract
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy, characterized by thrombocytopenia and high risk for venous and arterial thrombosis.
CASE REPORT: We report an unusual case of acute stent thrombosis secondary to delayed HIT. A 74-year-old man with non-ST-segment elevation myocardial infarction had a coronary angiography which revealed 2-vessel disease. A bolus of unfractionated heparin (UFH) was administered at admission and he received fondaparinux during his hospitalization. We performed elective percutaneous coronary intervention (PCI) with stents to LAD and LCx. Two hours after PCI, the patient developed acute pulmonary edema, and repeat angiography revealed an occlusive thrombus in the ostial LAD and the LCx. A turbidimetric assay for the rapid detection of plasma anti-PF4/heparin antibodies was negative. After repeated unsuccessful attempts of balloon angioplasty and continuous thrombosis, the patient was transferred for emergency surgical revascularisation and was treated with additional UFH followed by enoxaparin. Platelets decreased gradually to 38 k/μl 7 days after surgery, at which time enoxaparin was replaced with fondaparinux. The subsequent HIT test results were positive.
CONCLUSIONS: HIT should be considered in patients with multiple recent exposures to anticoagulants, independent of the platelet count, if there are signs and symptoms of thrombosis.
Keywords: Coronary Thrombosis, Heparin, Myocardial Infarction, Thrombocytopenia, Aged, Anticoagulants, Coronary Artery Disease, enoxaparin, Male, percutaneous coronary intervention, Stents, Thrombosis
SARS-CoV-2/COVID-19
19 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936370
17 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936651
13 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936589
13 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936574
In Press
24 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936600
23 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.935148
23 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936704
20 May 2022 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936826
Most Viewed Current Articles
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case report
DOI :10.12659/AJCR.934399
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
19 Feb 2022 : Case report
DOI :10.12659/AJCR.935355
Am J Case Rep 2022; 23:e935355