Heparin/low molecular weight heparins
- PDF / 142,483 Bytes
- 1 Pages / 623.591 x 841.847 pts Page_size
- 8 Downloads / 216 Views
1
S
Fatal heparin-induced thrombocytopenia and thrombosis syndrome in an elderly patient: case report A 77-year-old woman developed fatal heparin-induced thrombocytopenia (HIT) and thrombosis syndrome, after receiving unfractionated heparin; she had previously received unfractionated heparin and a low molecular weight heparin on separate occasions. The woman had a history of hypercholesterolaemia, hypertension and previous abdominal surgery. She was admitted for repair of a thoracoabdominal aortic aneurysm. Fifteen months earlier, she had received unfractionated heparin [dosage and duration of therapy not stated], for lower extremity deep vein thrombosis complicating vulvar carcinoma resection. She had also received a low molecular weight heparin [specific drug, dosage and duration of therapy not stated] for an incidence of deep vein thrombosis, associated with a fall, 8 months prior to her current admission. Preoperatively she had a platelet count of 383 000/µL. During the operation she received IV unfractionated heparin 5000U [indication not clearly stated]. The surgery was completed and she was transferred to the surgical intensive care unit, sedated and intubated. She had an arterial pH of 7.25, a PaCO2 of 39mm Hg and a platelet count of 186 000/µL [time to reaction onset not stated]. Over the subsequent hours her acidaemia worsened; 12 hours after admission she had a serum lactate level of 14.1 mmol/L, an AST level of 5760 U/L, an ALT level of 7481 U/L, a fibrinogen level of 178 mg/dL and a platelet count of 54 000/µL. All heparin sources were discontinued and a HIT antibody assay was obtained. Spiral CT angiography revealed occlusion of the aortic grafts to the right renal, celiac and superior mesenteric arteries. The woman underwent surgical reexploration, which revealed thrombotic occlusion of all aortic grafts, a viable but ischaemic liver and bowel and a necrotic spleen, which was removed. She underwent multiple thrombectomies and began receiving argatroban. Despite treatment, she continued to deteriorate and it was decided to withdraw interventions except comfort measures; she died shortly after. Her HIT antibody assay returned positive. Author comment: "Although it is possible that the present patient suffered from a pre-existing hypercoagulable state not related to HIT, her prior venous thromboses were attributed to the prothrombotic risks of an immobilized, postoperative and post-traumatic patient, respectively; she was treated and responded to standard anticoagulant therapy." Crimi C, et al. Fatal heparin-induced thrombocytopenia 8 months after prior exposure to heparin. Journal of Cardiothoracic and Vascular Anesthesia 22: 801124789 732-734, No. 5, Oct 2008 - USA
0114-9954/10/1231-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 6 Dec 2008 No. 1231
Data Loading...
