Heparin-Induced Thrombocytopenia in a Patient with Essential Thrombocythemia: A Case Based Update

Abstract

Vascular thrombosis is a common clinical feature of both essential thrombocythemia (ET) and heparin-induced thrombocytopenia (HIT). The development of HIT in a patient with ET is rare and underrecognized. We report the case of a 77-year-old woman with preexisting ET, who was admitted with acute coronary syndrome, and IV heparin was started. She was exposed to unfractionated heparin (UFH) 5 days prior to this admission. Decrease in platelet count was noted, and HIT panel was sent. Heparin was discontinued. Patient developed atrial fibrillation, and Dabigatran was started. On day three, patient also developed multiple tiny cerebral infarctions and acute right popliteal DVT. On day ten of admission, HIT panel was positive, and Dabigatran was changed to Lepirudin. Two days later, Lepirudin was also discontinued because patient developed pseudoaneurysm on the right common femoral artery at the site of cardiac catheterization access. A progressive increase in the platelet count was noted after discontinuing heparin. Physicians should be aware of the coexistence of HIT and ET, accompanied challenges of the prompt diagnosis, and initiation of appropriate treatment.

Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review

“…45 {Patient with essential thrombocythemia developed HIT with platelet count fall from 750 to 216 3 10 9 /L; dabigatran was given for atrial fibrillation, as the clinicians initially deemed HIT to be unlikely; however, signs of stroke became evident shortly thereafter with computed tomography imaging confirming multiple cerebral infarcts; when the serotonin-release assay returned positive for HIT antibodies, dabigatran was switched to lepirudin. BLOOD, 31 AUGUST 2017 x VOLUME 130, NUMBER 9 RIVAROXABAN AND OTHER DOACs FOR TREATMENT OF HIT 1111…”

“…by guest www.bloodjournal.org From Only 1 patient had a possible thrombotic event while receiving a DOAC (multiple strokes, which might have been present before starting dabigatran). 45 None of the patients experienced major bleeding.…”

Dabigatran as a Treatment Option for Heparin‐Induced Thrombocytopenia

“…None of the patients experienced major hemorrhagic events. [12][13][14][15][16][17][18][19] The profile of our patients matched those in group A of the study mentioned above. Our results also indicated dabigatran to be effective in preventing recurrent or new thrombosis, in all but 1 patient, who experienced DVT on the opposite leg, which was not found to be a result of dabigatran failure.…”

“…Among the 12 patients who received dabigatran for HIT management, only 1 patient had a possible thrombotic event while receiving a DOAC (multiple strokes, which might have been present before starting dabigatran). None of the patients experienced major hemorrhagic events …”

“…10,11 There are only a few case reports in the literature evaluating the clinical use of dabigatran in HIT. [12][13][14][15][16][17][18] In our study, we identified patients with suspected HIT who were treated with dabigatran and followed them for 12 months for efficacy and safety.…”