[Successful lysis of iliofemoral and inferior vena cava thrombi in heparin-induced type-II thrombocytopenia].
METHODS
After 10 days of intravenous heparin treatment of a 25-year-old woman with recurrent pulmonary emboli, thrombocytopenia occurred with a platelet drop from 1.52 x 10(5)/microliter to 3.6 x 10(4)/microliter. Heparin-induced platelet activation assays confirmed the diagnosis of heparin-induced thrombocytopenia (HIT). The detected heparin-dependent antibodies exhibited in vitro cross-reactivity with low-molecular-weight heparins, but not with danaparoid.


METHODS
After heparin was stopped and platelet counts were normal, a massive thrombosis of the iliofemoral veins and the inferior vena cava occurred. Under protection of a temporary vena cava filter, systemic anticoagulation with danaparoid (anti-factor Xa-activity 0.4-0.8 U/ml) and transcatheter thrombolysis with urokinase (70,000 U/h) was initiated. Within 8 days of treatment a complete recanalisation of the occluded iliofemoral and caval veins was achieved. Oral anticoagulation with phenprocoumon was started and the patient has since then been free of symptoms.


CONCLUSIONS
The case demonstrates successful treatment of massive iliofemoral and caval thrombosis in the HIT syndrome achieved by combined transcatheter administration of urokinase and systemic infusion of danaparoid.
Emig
U
U
Medizinische Klinik, Georg-August-Universität Göttingen.
Meyer
T
T
Buchwald
A B
AB
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D003871:Dermatan Sulfate / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005268:Femoral Vein; D006493:Heparin / Q000009:adverse effects*; D006496:Heparinoids / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000627:therapeutic use; D006801:Humans; D007084:Iliac Vein; D010960:Plasminogen Activators / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000188:drug therapy; D012008:Recurrence; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006496:Heparinoids; D006497:Heparan Sulfate; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator; C035838:danaparoid