[Heparin-associated type II thrombocytopenia as a cause of multiple thromboembolism complications].
13 days after hysterectomy and subcutaneous treatment with unfractionated heparin (10000 IU daily) a 68 year old women developed a pulmonary embolism and deep vein thrombosis of the right leg. She thereupon received intravenous heparin (1000 IU/h). Eight days later she developed acute ischaemia of both legs, and Doppler examination revealed acute Leriche's Syndrome with thrombosis of both iliac arteries. Platelet count fell from, initially 152 x 10(9)/I, to 44 x 10(9)/I. Although heparin-associated thrombocytopenia type II was suspected a confirmation by demonstrating a heparin dependent antibody with the heparin-induced platelet activation (HIPA)-test failed and therefore crossreactivity of low molecular heparins or heparinoids could not be assessed. After discontinuation of heparin and iliacal artery thrombectomy a combination therapy with aspirin plus ticlopidine (500 mg/d respectively) was started and continued until phenprocoumon could exert its full effect. No recurrent thromboembolic events occurred, the platelet counts normalized and the patient fully recovered.
Scheffold
N
N
Medizinische Klinik I des Städtischen Krankenhauses Heilbronn.
Kuthan
P
P
Cyran
J
J
D000368:Aged; D001780:Blood Coagulation Tests; D003952:Diagnostic Imaging; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007045:Hysterectomy, Vaginal; D007511:Ischemia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D007866:Leg / Q000098:blood supply; D010976:Platelet Count / Q000187:drug effects; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D011655:Pulmonary Embolism / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D013924:Thrombophlebitis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D014596:Uterine Prolapse / Q000097:blood / Q000601:surgery*
D006493:Heparin
Heparin-assoziierte Thrombozytopenie Typ II als Ursache multipler thromboembolischer Komplikationen.