A new manifestation and treatment alternative for heparin-induced thrombosis.
We treated a coronary artery bypass patient whose postoperative course was complicated by heparin-induced thrombocytopenia and resultant pulmonary artery and saphenous vein graft thromboses. The pulmonary thromboemboli were found first, and pulmonary blood flow was restored with intravenously administered tissue plasminogen activator (tPA). A short time later, the vein grafts were found to be occluded, and we subsequently performed multivessel percutaneous transluminal coronary angioplasty (PTCA) using tPA as an adjuvant to oral warfarin sodium therapy with excellent results. We conclude that heparin-induced thromboses in the pulmonary arteries are amenable to thrombolytic therapy, including tPA, whereas this regimen appears to have little effect on saphenous vein grafts. We also found that a combination of warfarin and thrombolytic therapy is an alternative regimen for heparin-intolerant patients who require PTCA.
Dieck
J A
JA
Division of Adult Cardiology, Texas Heart Institute, Houston.
Rizo-Patron
C
C
Unisa
A
A
Mathur
V
V
Massumi
G A
GA
D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D006083:Graft Occlusion, Vascular / Q000139:chemically induced / Q000628:therapy; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000139:chemically induced; D012501:Saphenous Vein / Q000637:transplantation; D013921:Thrombocytopenia / Q000139:chemically induced; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000139:chemically induced* / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
D014859:Warfarin; D006493:Heparin; D010959:Tissue Plasminogen Activator