Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery

Abstract

Heparin-induced thrombocytopenia with thrombosis (HITT) is a rare complication of cardiac surgery with cardiopulmonary bypass. We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Lepirudin administration in the first case. In the second, the presence of an intra-aortic balloon pump delayed HITT recognition, and Lepirudin infusion could not prevent limb amputation. In both cases HITT occurred earlier (< 5 days after heparin exposure) than its usual presentation.

Thrombocytopenia in Patients Treated with Heparin, Combination Antiplatelet Therapy, and Intra‐Aortic Balloon Pump Counterpulsation

“…Thus, should platelet counts decline, clinicians confront the uncertainty of the thrombocytopenia being IABP‐associated or due to heparin‐induced thrombocytopenia (HIT). Although only a small minority of heparinized patients (1–3%) 12–16 experience this reaction, the clinical consequences can be severe 17,18 …”

“…Although only a small minority of heparinized patients (1-3%) [12][13][14][15][16] experience this reaction, the clinical consequences can be severe. 17,18 Many contemporary IABP patients are now treated with one or more antiplatelet medications including the glycoprotein IIb/IIIa receptor (GP IIb/IIIa) antagonists (abciximab, eptifibatide, and tirofiban) and the thienopyridine clopidogrel. Both classes have been reported to cause thrombocytopenia.…”

Delayed-onset heparin-induced thrombocytopenia presenting with multiple arteriovenous thromboses: case report

“…When HITT develops postoperatively, heparin must be discontinued and alternative anticoagulant agents given. Alternative anti coagulant agents are intravenous hirudin, argatroban, danaproid or lepirudin [ 6 - 8 ]. Warfarin is recommended to start simultaneously with hirudin or other alternative anticoagulants except heparin.…”