Heparin
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Heparin-induced thrombocytopenia and other toxicities: case report A 66-year-old man developed persistent fever, abdominal haematoma, tissue necrosis and lower extremity venous thrombosis secondary to heparin-induced thrombocytopenia (HIT) following anticoagulant treatment with heparin. The man, who was diagnosed with gastric cancer, was hospitalised and underwent a laparoscopic radical gastrectomy under unspecified general anaesthesia. Prior to the surgery, he had started receiving anticoagulation therapy with heparin [sulphonated heparin sodium] administered by deep vein catheterisation [route and dosage not stated]. He was also treated with concomitant nadroparin calcium and fondaparinux sodium. On the sixth day after the surgery, his body temperature increased. No obvious abnormality was noted in inflammatory index, blood culture and blood routine test [time to reaction onsets not clearly stated]. The man was treated with unspecified antibiotics. However, his body temperature did not decrease. On the eighth day after the initiation of heparin therapy, he developed lower extremity venous thrombosis. He was treated with naltrexone. His high fever persisted. Color Doppler ultrasonography revealed an abdominal haematoma. His Hb level continued to decrease. Initially, spontaneous intra-abdominal haemorrhage was suspected. Therefore, on the thirteen day after the first operation, he underwent laparotomy under unspecified general anaesthesia. A haematoma had formed beside the pancreas. During the operation, some tissue necrosis was also noted. A large number of thrombosis could be seen in the necrotic tissue. On the second day after operation, blood routine examination revealed drop in platelet count. He was diagnosed with HIT. Therefore, heparin therapy was discontinued. His blood sample tested positive for HIT antibody. He continued to receive fondaparinux sodium. Subsequently, his fever and platelet count recovered. He was discharged on the eighteenth day after the second surgery following improvement in his condition. Wu W, et al. Heparin-induced thrombocytopenia with hematoma necrosis and persistent high fever after gastric cancer surgery: A case report. Asian Journal of Surgery 43: 803506623 387-388, No. 1, Jan 2020. Available from: URL: http://doi.org/10.1016/j.asjsur.2019.10.012
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Reactions 17 Oct 2020 No. 1826
