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Heparin-induced thrombocytopenia and lack of efficacy: case report A 54-year-old woman developed heparin-induced thrombocytopenia following treatment with heparin. Subsequently, she exhibited lack of efficacy following treatment with argatroban as anticoagulant therapy [routes, dosages, time to reaction onset and outcome not stated; not all indications stated]. The woman was hospitalised with severe COVID-19 pneumonia. Three days later, her respiratory condition worsened requiring mechanical ventilation. However, sufficient gas exchange could not be established. Therefore, she was initiated on veno-venous extracorporeal membrane oxygenation. She was treated with heparin. However, during her hospital stay, she developed heparininduced thrombocytopenia. The woman was initiated on anticoagulation therapy with argatroban. Despite sufficient anticoagulation with argatroban, she developed multiple thrombi in the area of the inferior vena cava, the right atrium, and the pelvic veins. CT angiography revealed a central pulmonary artery embolism with occlusion of the lower right and middle pulmonary artery. The thrombosis and pulmonary artery embolism were suspected to be secondary to heparin-induced thrombocytopenia. Her respiratory situation had improved in the meantime. Therefore, extracorporeal membrane oxygenation was terminated. She underwent percutaneous thrombectomy. Following one minute of aspiration through femoral access under transoesophageal echocardiographic control, thrombus formation could no longer be visualised. The blood filter was flushed, demonstrating large thrombus trapped on the filter. Schmiady MO, et al. Successful percutaneous thrombectomy in a patient with COVID-19 pneumonia and acute pulmonary embolism supported by extracorporeal membrane 803517818 oxygenation. European Heart Journal 41: 3107, No. 32, 21 Aug 2020. Available from: URL: http://doi.org/10.1093/eurheartj/ehaa403

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Reactions 28 Nov 2020 No. 1832