• PDF / 142,293 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 39 Downloads / 134 Views

DOWNLOAD

REPORT

---

1

S

Gangrene and fatal pulmonary haemorrhage: case report A 58-year-old woman developed gangrene and fatal pulmonary haemorrhages during treatment with argatroban and warfarin [routes not stated] for deep vein thrombosis (DVT). The woman, who had a history of suspected heparininduced thrombocytopenia, was admitted (day 0) with upper limb DVT and was given a single dose of warfarin 5mg. Also on day 0, argatroban therapy was initiated at 0.4 µg/kg/min. Five hours later it was withdrawn, then reinitiated at 0.1 µg/kg/min and later increased to 0.2 µg/kg/min. Her thrombosis progressed and her INR rose, and on day 2 she developed compartment syndrome. Argatroban was discontinued and the woman received emergent fasciotomies of her right upper extremity. On day 3, fondaparinux sodium was initiated due to progressive ischaemia in her right hand, and she received platelets. Her INR continued to rise and she was switched back to argatroban on day 4; her dosage was adjusted to maintain an activated partial thromboplastin time of over 100 seconds. Doppler ultrasound revealed DVT involving proximal and distal subclavian, axillary and brachial veins, and superficial vein thrombosis (SVT) in the right cephalic vein. DVT and SVT were also seen on the left side. She received methylprednisolone, IV immune globulin and later, packed red blood cell transfusion. On day 12 her fingers of her right hand were gangrenous, and cefazolin was initiated. Over days 13-16, her anti-IIa levels ranged from 0.4-2.2 µg/mL, while her dosage of argatroban were between 1.0-1.2 µg/kg/min. Doppler examination on day 18 revealed further progression of her thromboses, and her right radial pulse was consistently undetectable. Hypoxia and acute respiratory failure developed on day 19 and she was intubated. Bronchoscopy revealed bilateral pulmonary haemorrhages and she died later that day, 7 hours after intubation, with supratherapeutic anti-IIa levels. Author comment: "[Venous limb gangrene] likely resulted from the combination of warfarin and interruption of argatroban therapy . . . [E]xcessive argatroban anticoagulation was believed to explain the fatal hemorrhage." Smythe MA, et al. Venous limb gangrene and fatal hemorrhage: Adverse consequences of HIT "overdiagnosis" in a patient with antiphospholipid syndrome. American Journal of Hematology 86: 188-191, No. 2, Feb 2011. Available from: 803050144 URL: http://dx.doi.org/10.1002/ajh.21916 - USA

0114-9954/10/1340-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved

Reactions 26 Feb 2011 No. 1340