Heparin-induced thrombocytopenia and thrombosis: presentation after cardiopulmonary bypass.
Heparin-induced thrombocytopenia and thrombosis syndrome was diagnosed in a 63-year-old woman 11 days after coronary artery bypass grafting. Her only presenting complaints were incisional leg pain and vague chest discomfort. The syndrome was suspected when her platelet count was found to be 37,000/microL. A subsequent ventilation-perfusion lung scan showed findings highly probable for pulmonary embolism. An inferior venacavogram obtained before a pulmonary angiogram revealed a large retrohepatic thrombus at the right atrial junction. The patient was successfully treated with the defibrinogenating agent ancrod (Arvin). A diagnosis of heparin-induced thrombocytopenia and thrombosis syndrome should be considered and heparin therapy should be avoided in patients with low platelet counts who have been previously treated with heparin.
Munver
R
R
New York Hospital-Cornell University Medical College, New York 10021.
Schulman
I C
IC
Wolf
D J
DJ
Rosengart
T K
TK
D000721:Ancrod / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005268:Femoral Vein; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced*; D011655:Pulmonary Embolism / Q000139:chemically induced / Q000188:drug therapy; D013921:Thrombocytopenia / Q000139:chemically induced*; D013927:Thrombosis / Q000139:chemically induced* / Q000188:drug therapy; D014682:Vena Cava, Inferior
D006493:Heparin; D000721:Ancrod