Acute Left Main Occlusion During Percutaneous Coronary Intervention Associated with Heparin Induced Thrombocytopenia with Thrombosis Syndrome

Abstract

A 76-year-old male was admitted with Braunwald IIIB unstable angina and treated with intravenous heparin. Coronary angiography 20 days later revealed a severe stenosis in the left circumflex artery. During coronary angioplasty thrombus developed in the circumflex artery, extended in the left main and lead to its occlusion. Normal left coronary artery patency and flow were achieved after intracoronary and intravenous administration of abciximab, and multiple stenting. Platelet-count decrease and an ELISA assay documented the presence of heparin-induced thrombocytopenia with thrombosis syndrome (HITTS). HITTS should be suspected after acute thrombus formation during coronary angioplasty.

Allograft Coronary Artery Thrombosis: A Case Report of Early Cardiac Allograft Left Ventricular Myocardial Infarction

“…9 however, involvement of the coronary circulation is extremely rare; in the setting of postcardiac transplantation hitt syndrome, coronary artery thrombosis has only been reported in association with percutaneous coronary interventions and to our knowledge has not been reported as a spontaneous occurrence. 10,11 Conclusion our patient suffered intracoronary thrombosis early after cardiac transplantation in the absence of overt pre-existing coronary artery disease. the nature of this event was most likely multifactorial and due to prolonged ischemia time, donor brain death, cytomegalovirus mismatch, and acute allograft cellular rejection.…”

Native coronary artery thrombosis in the setting of heparin-induced thrombocytopenia: a case report

“…This can manifest in acute myocardial ischaemia and can be a life-threatening emergency when it occurs. There had been previous reported cases of HIT causing coronary thrombus formation, however most in the setting of either previous coronary intervention, stenting or in coronary bypass grafts 4–10 …”

“…Venous thrombosis is far more common than arterial thrombosis in HIT, although both occur. In patients with HIT, native coronary arteries are rarely implicated by thrombus formation and this almost always occurs in the setting of venous coronary grafts or previous coronary interventions 4–10 . Here, we describe a case of thrombus formation in a native coronary artery causing an ST-elevation myocardial infarct (STEMI) secondary to HIT.…”

A Case of Acute Coronary Artery Occlusion Associated with Very Rapid Onset Heparin-induced Thrombosis without Thrombocytopenia

“…Sakai et al (9) reported a case of inferior acute myocardial infarction where thrombi appeared in the LCX and LAD 40 minutes after readministration of heparin during elective PCI, which was performed 21 days after conservative treatment with heparin. Ziakas et al (10) described a case of unstable angina where thrombi appeared in the LCX and in the left main trunk of the coronary artery 50 minutes after readministration of heparin during elective PCI. Mibiki et al (11) also reported a case of acute simultaneous thrombosis of three coronary vessels during elective PCI on day 17.…”