Thrombocytopenia due to acute venous thromboembolism and its role in expanding the differential diagnosis of heparin‐induced thrombocytopenia

Abstract

Thrombocytopenia is an uncommon but serious consequence of heparin administration. Occasionally patients with massive acute venous thromboembolism (VTE) will develop thrombocytopenia. As heparin or some thrombin inhibitor is strongly indicated in acute VTE, it is important to distinguish this event from heparin-induced thrombocytopenia (HIT). Four patients are presented who developed thrombocytopenia so early in their course of VTE and/or therapy with heparin that HIT was considered unlikely. The mean nadir platelet count for these four patients was 60,000/ml occurring at a mean time of 18 hr after the initiation of heparin therapy. Because of strong indications to continue heparin for their acute VTE in the face of a very low likelihood that they did have HIT, heparin was continued with excellent results and resolution of the thrombocytopenia. The literature of this subject is reviewed. Thrombocytopenia following VTE is actually rather common, but it is usually milder than in these four cases. In some cases such as these four, the thrombocytopenia can be sudden and rather severe causing diagnostic confusion with HIT. Am.

All-Cause and Potentially Disease-Related Health Care Costs Associated with Venous Thromboembolism in Commercial, Medicare, and Medicaid Beneficiaries

“…Heparininduced thrombocytopenia can complicate heparin therapy for VTE, 21 and thrombocytopenia not related to heparin usage may also be developed by patients with VTE. 22 Superficial venous thrombosis has been described as a venous condition interrelated with VTE, 23 and at the beginning of a large prospective study of patients with superficial venous thrombosis, about one-quarter also had DVT. 24 Venous ulcer and pulmonary hypertension have been reported as major complications of VTE.…”

“…Additional exploratory endpoints were identified a priori based on the literature reviewed by the authors during the study protocol development prior to conducting the study analyses. [21][22][23][24][25][26][27][28][29][30][31] These exploratory endpoints included thrombocytopenia, superficial venous thrombosis, venous ulcer, pulmonary hypertension, stasis dermatitis, and venous insufficiency (Appendix).…”

DIC score predicts mortality in massive clot coagulopathy as a result of extensive pulmonary embolism: a rebuttal

“…For these reasons, I would disagree with the authors that massive PE needing resuscitation is associated with DIC but may rephrase the abnormal parameters in this clinical context as ÔMassive Clot CoagulopathyÕ. A similar concept of Ôclot-associated thrombocytopeniaÕ was reported in four patients who developed severe thrombocytopenia in the context of massive venous thromboembolism with the platelet count varying from 30 to 80 · 10 9 l )1 [3]. The author described the clot-associated thrombocytopenia to be secondary to large fresh clots consuming platelets on their surface.…”

When Heparins Promote Thrombosis

“…Patients with massive, acute venous thromboembolism occasionally develop thrombocytopenia because of platelet consumption on the thrombus surface; their platelet count nadir usually happens within 1 day of heparin initiation. 59 Besides HIT, thrombotic "storms" also occur in the anti-phospholipid antibody syndrome, Trousseau's syndrome, cholesterol emboli syndrome, and infective or nonbacterial thrombotic endocarditis. HIT should be also considered if a recently hospitalized patient returns with thromboembolism.…”