[Success of treatment with a low-molecular-weight heparin fraction in a case of pulmonary embolism complicated by heparin-induced thrombopenia].
A 40-year-old woman was admitted to Ambroise-Paré Hospital with a mitral stenosis and right ventricular failure. On the admission, heparino-therapy was started (Heparine Calcique Leo 30,000 IU/24 h); 11 days after, a thrombocytopenia (platelet count 60 . 10(9)/l) was observed and a few days later a pulmonary embolus was diagnosed. "In vitro", a heparin dependent plasma platelet aggregating factor was found (with Heparine Leo and all other standard ones tested) leading to the diagnosis of heparin associated thrombocytopenia; on the other this aggregating factor was not found with a low molecular weight (LMW) heparin fraction (Choay laboratory, Paris, batch CY216). We decided to stop standard heparin and to treat this patient with the LMW fraction (7,500 IU every 8 h SC) associated with oral antivitamin K. A rapid clinical improvement was observed and the platelet count rose progressively reaching 300 . 10(9)/l and has subsequently always been greater than 200 . 10(9)/l. The occurrence of heparin induced thrombocytopenia associated with thrombosis leads to heparin cessation; the treatment of the thrombotic episode seems to be improved by the use of LMW heparin associated with vitamin K antagonists.
D000328:Adult; D001779:Blood Coagulation Factors / Q000032:analysis; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008970:Molecular Weight; D010972:Platelet Activating Factor; D010974:Platelet Aggregation / Q000187:drug effects; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000150:complications
D001779:Blood Coagulation Factors; D010972:Platelet Activating Factor; D006493:Heparin
Succès du traitement par une fraction d'héparine de bas poids moléculaire dans un cas d'embolie pulmonaire compliquant une thrombopénie induite par l'héparine.