Acute Thrombotic Thrombocytopenic Purpura Following Orthopedic Surgery: Case Report and Review of the Literature

Yenigun, Ezgi Coskun; Bardak, Simge; Piskinpasa, Serhan; Öztürk, Ramazan; Turgut, Didem; Koc, Eyup; Dede, Fatih

doi:10.3109/0886022x.2012.692750

Cited by 7 publications

(5 citation statements)

References 15 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The development of TTP after orthopedic surgery is not common [5][6][7]. Among cases of TTP that do develop after orthopedic surgery, the case reported here is unique because it was accompanied by RVHF.…”

Section: Case Reportmentioning

confidence: 80%

Acute Thrombotic Thrombocytopenic Purpura with Right Heart Failure Following Total Knee Replacement Surgery

Shim¹,

Lim²,

Koh³

et al. 2018

Korean J Med

View full text Add to dashboard Cite

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, renal insufficiency, neurological abnormalities, and fever. Cardiac involvement is not uncommon and can be fatal; however, right ventricular heart involvement after surgery is rare. Here, we report a case of TTP presenting with right ventricular heart failure after total knee replacement surgery. TTP was successfully treated with four rounds of plasma exchange. The patient made a full recovery and was discharged after 11 weeks.

show abstract

Section: Case Reportmentioning

confidence: 80%

Acute Thrombotic Thrombocytopenic Purpura with Right Heart Failure Following Total Knee Replacement Surgery

Shim¹,

Lim²,

Koh³

et al. 2018

Korean J Med

View full text Add to dashboard Cite

show abstract

“… In addition, five patients developed TMA following orthopedic procedures. Median time to clinical manifestations of TMA was 4 days (range, 1‐30). ADAMTS13 activity was performed in 18/65 (27.6%) individuals.…”

Section: Resultsmentioning

confidence: 99%

“…17,33,[38][39][40][41][42] In addition, five patients developed TMA following orthopedic procedures. [43][44][45][46][47] Median time to clinical manifestations of incompatible red blood cell transfusion. 15 Of the two patients requiring other therapy in addition to TPE, one patient who developed TMA after mitral valvuloplasty, underwent repeat valvuloplasty with improvement in TMA symptoms.…”

Section: Literature Reviewmentioning

confidence: 99%

“…17,33,[38][39][40][41][42] In addition, five patients developed TMA following orthopedic procedures. [43][44][45][46][47] Median time to clinical manifestations of Outcomes of the five patients not receiving TMA directed treatment included death in three patients and it was reported that these patients had a delay in diagnosis of TMA. 17,39 Two patients who developed TMA after CABG or myocardial sarcoma resection 16 had spontaneous remissions, although the patient who developed TMA after CABG required amputation of several digits due to initial presentation with peripheral digit ischemia.…”

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Postsurgical thrombotic microangiopathy: Case series and review of the literature

Sridharan

Hook

Leung

et al. 2019

European J of Haematology

View full text Add to dashboard Cite

Objectives Describe the clinical presentation, treatment, and outcomes of postsurgical thrombotic microangiopathy (TMA). Methods In this retrospective study, records of individuals diagnosed with TMA developing within 30 days of a surgical procedure at Mayo Clinic from 2000 to 2016 were reviewed. Available literature regarding postsurgical TMA was comparatively reviewed. Results Twenty patients were diagnosed with TMA developing within 30 (median 6.5, range (1‐28)) days) following a procedure. Preceding procedures included orthopedic (n = 4), vascular (n = 4), abdominal (n = 8), thoracic (n = 2), and other (n = 2). Review of the literature identified 65 patients with postsurgical TMA and cardiovascular procedures were the most common preceding surgery. The majority of patients in the current cohort and literature were treated with therapeutic plasma exchange (TPE). Among the evaluable patients in the current cohort, 100% demonstrated response to TPE; however, 25% required the addition of other therapy including eculizumab to maintain a response 80% of patients in the literature demonstrated a response to TPE. Conclusions Although rare, early recognition and treatment of postsurgical TMA can lead to good outcomes. More research is necessary to determine the underlying pathophysiology and optimal treatment for postsurgical TMA.

show abstract

“…The treatment differs, however, in that anticoagulant therapy is not typically administered in patients with SLE and TTP. Although most patients do not have a specific precipitating event, TTP has been reported to occur after infections, 23 surgical procedures, 24 and in patients with pancreatitis. 25 The pattern of thrombotic events and laboratory findings help distinguish TTP from the other catastrophic thrombotic disorders (Table 1).…”

Section: Introductionmentioning

confidence: 99%

How I treat catastrophic thrombotic syndromes

Ortel

Erkan

Kitchens

2015

Blood

View full text Add to dashboard Cite

Catastrophic thrombotic syndromes are characterized by rapid onset of multiple thromboembolic occlusions affecting diverse vascular beds. Patients may have multiple events on presentation, or develop them rapidly over days to weeks. Several disorders can present with this extreme clinical phenotype, including catastrophic antiphospholipid syndrome (APS), atypical presentations of thrombotic thrombocytopenic purpura (TTP) or heparin-induced thrombocytopenia (HIT), and Trousseau syndrome, but some patients present with multiple thrombotic events in the absence of associated prothrombotic disorders. Diagnostic workup must rapidly determine which, if any, of these syndromes are present because therapeutic management is driven by the underlying disorder. With the exception of atypical presentations of TTP, which are treated with plasma exchange, anticoagulation is the most important therapeutic intervention in these patients. Effective anticoagulation may require laboratory confirmation with anti–factor Xa levels in patients treated with heparin, especially if the baseline (pretreatment) activated partial thromboplastin time is prolonged. Patients with catastrophic APS also benefit from immunosuppressive therapy and/or plasma exchange, whereas patients with HIT need an alternative anticoagulant to replace heparin. Progressive thrombotic events despite therapeutic anticoagulation may necessitate an alternative therapeutic strategy. If the thrombotic process can be controlled, these patients can recover, but indefinite anticoagulant therapy may be appropriate to prevent recurrent events.

show abstract

Acute Thrombotic Thrombocytopenic Purpura Following Orthopedic Surgery: Case Report and Review of the Literature

Cited by 7 publications

References 15 publications

Acute Thrombotic Thrombocytopenic Purpura with Right Heart Failure Following Total Knee Replacement Surgery

Acute Thrombotic Thrombocytopenic Purpura with Right Heart Failure Following Total Knee Replacement Surgery

Postsurgical thrombotic microangiopathy: Case series and review of the literature

How I treat catastrophic thrombotic syndromes

Contact Info

Product

Resources

About