Enoxaparin sodium/heparin
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Thrombocytopenia in an elderly patient: case report A 68-year-old man who had received enoxaparin sodium and heparin, developed thrombocytopenia. The man, who had a history of cardiovascular disease, was admitted to an emergency department with dyspnoea. He had undergone surgery 2 months previously for a right femoral fracture. The surgery had gone well and he had received SC enoxaparin sodium twice daily [dose not stated] for 15 days. On the current admission, an ECG detected a mobile thrombus in the right atrium and a lung CT scan showed bilateral pulmonary involvement. He received thrombolysis with alteplase and heparin [dosage and route not stated] according to activated partial thromboplastin time (APTT). His arterial blood gases were monitored and showed an improvement in oxygen saturation, an increase in BP and a reduction in heart rate and dyspnoea 30 minutes after thrombolysis. He continued to receive heparin (1000 U/hour and/or according to APTT) and oxygen. Six hours after thrombolysis his platelet count fell by approximately 50 000/mL from a baseline of 182 000/mL. He developed bleeding gums 3 hours after thrombolysis. Heparin was withdrawn and the man received an infusion of bivalirudin and oral vitamin K antagonists. Bivalirudin was titrated according to APTT and activated clotting time every 6 hours until his INR was within the therapeutic range. His platelet count increased to approximately 200 000/mL 3 days later and bivalirudin was discontinued on day 5. He was discharged after 10 days with an INR of 2.5–3.5 and warfarin therapy. A follow up at 3 months did not reveal further thrombosis and he remained in good health over the next 6 months. Author comment: Heparin-induced thrombocytopenia "probably could be attributed to the long use of [enoxaparin sodium] in the previous months (15 days). This is only a hypothesis because no sensitising test was performed. Also for this reason, we discontinued heparin infusion". Fasullo S, et al. Use of bivalirudin for heparin-induced thrombocytopaenia after thrombolysis in massive pulmonary embolism: A case report. International Journal of Emergency Medicine 3: 197-199, No. 3, Sep 2010. Available from: URL: http:// 803044208 dx.doi.org/10.1007/s12245-010-0193-9 - Italy
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Reactions 27 Nov 2010 No. 1329
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