Coronary Artery Stent Thrombosis Associated with Heparin‐Induced Thrombocytopenia: Case Report and Review of the Literature

Abstract

The diagnosis of an acute coronary syndrome associated with heparin-induced thrombocytopenia is an increasingly recognized complication of heparin exposure. We describe a case of an acute myocardial infarction 2 weeks after elective aortobifemoral bypass surgery, subsequent subacute coronary artery stent thrombosis, and the treatment strategies available.

HITT and stent thrombosis: A “CLINICAL” diagnosis not to be missed

“…The primary explanation for this may be the short duration of exposure to heparin with percutaneous intervention. A second factor may be the use of glycoprotein IIbIIIa inhibitors and clopidogrel, which may potentially inhibit some of the thrombotic events that may otherwise have occurred [2]. The use of bivalirudin in the catheterization laboratory and subsequent transition to danaparoid were critical steps in the prevention of further thrombotic events in our patient.…”

“…Two previous cases of stent thrombosis have been reported secondary to HITT [1,2]. HITT is primarily a clinical diagnosis which is then confirmed with an antibody or functional platelet activation or aggregation assay [3].…”

Anticoagulation in Patients with Heparin-Induced Thrombocytopenia undergoing Percutaneous Coronary Angiography and Interventions

“…A prospective study with 254 ACS patients treated with heparin showed that the incidence of HIT/HITTS is 1.6/0.8% [58], whereas another study showed that the overall incidence of isolated profound thrombocytopenia in interventional cardiology ranges between 0.7% and 1.5% [59]. HIT during PCI may lead to potential life-threatening thrombosis in native vessels or intracoronary stents leading to acute myocardial infarction [60,61].…”

Percutaneous Coronary Intervention in Patients with Heparin Induced Thrombocytopenia: Case Report and Review of Literature

“…A case of spontaneous thrombus formation in the left main and RCA ostia has been described in the setting of HIT following aortic valve replacement in a patient on UFH [9]. Other similar cases of acute and sub-acute stent thrombosis have been described in patients with HIT [10]. There have been smaller studies testing patients presenting with acute coronary syndrome (ACS) for the presence of HIT antibodies.…”