Nadroparin calcium
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Nadroparin calcium Heparin-induced thrombocytopenia: case report
A 62-year-old woman developed heparin-induced thrombocytopenia (HIT) during antithrombotic treatment with nadroparin calcium. The woman, who had obesity, hypertension and type 2 diabetes mellitus, was hospitalised for an inveterate untreated burn on the right breast (third-degree burn) on 10 January 2019. She had been receiving several medications, and was allergic to penicillin. Physical examination revealed a putrid-smelling phlegmon of the right breast in the field of third-degree burns, which affected approximately 5% of the total body surface area and another smaller locus of third-degree burn in the right mesogastrium. Laboratory investigations revealed remarkable leucocytosis, significantly elevated CRP and a retention of nitrogen catabolites in serum. On admission, she was started on antithrombotic treatment with nadroparin calcium [nadroparin; route not stated] 50 U/kg body weight. At the same time, she was started on vancomycin and meropenem. On the next day, she underwent an extensive necrectomy with the evacuation of the purulent contents from the deeper tissues of the right breast. Bacteriological examination of the pus showed presence of gram-positive cocci of Streptococcus pyogenes and Staphylococcus aureus; however, anaerobic cultures were found to be negative. Considering the risk of bleeding from the wounds, her antithrombotic prophylaxis was replaced with continuous IV administration of nadroparin calcium at a dose of approximately 32 U/kg of body weight. A temporary tendency of phlegmon regression was noted; however, on 17 January 2019, another abscess was evacuated from the right breast area. On 25 Janurary 2019, she underwent debridement, necrectomy and transfer of an autologous skin graft from the area of the right thigh. On 30 January 2019, an incision was made and a thrombotic vein resection was performed. Thereafter, at the contralateral side of incision and in the right lower abdomen, a noticeable lividly stained nodosite of approximately 5 x 5cm with a wide erythematous rim was noted. Also, an asymmetric pasty swelling of the left lower limb with numerous petechias was noted, especially in the area of skin contact with the pad. Based on these observations, a differential diagnosis of a phlegmon was made. At the same time, she was suspicious for HIT. Immediately screening test was performed, which was found to be positive. Acute examination of the left lower limb and left upper limb showed acutely supplemented and there was no evidence of thrombotic venous occlusion. The woman’s treatment with nadroparin calcium was discontinued. She was started on prophylactic therapy with fondaparinux [Arixtra] considering her fresh and relatively extensive surgical injury and renal insufficiency. The following day, a functional test of platelet aggregation and flow cytometric examination were positive, which confirmed HIT. Laboratory investigations revealed slightly elevated platelet count. On day 4 of nadroparin calcium discontinua
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