Can a coated Dacron vascular graft maintain a heparin-induced thrombocytopenia type II?
In the course of reconstruction of peripheral arterial occlusion processes, two gelatin-coated Dacron grafts and one collagen-coated Dacron patch were implanted in a 52-year-old male patient. Eight days following low-dose heparinization (5 days prior to surgery, 3 days postoperatively) with unfractionated heparin, with no clinical symptoms present, a dramatic isolated thrombocyte depression occurred, from 212 Gpt/l prior to surgery to 14 Gpt/l on postoperative day 3. Laboratory tests verified an HIT type II [heparin-induced platelet aggregation assay (HIPAA) and ELISA]. Despite immediate discontinuation of heparin and commencement of an anticoagulant therapy with Revasc and Refludan, an 8-week thrombocyte depression occurred which was eliminated only temporarily by administration of gammaglobulin. The specific antibody tests turned out positive for more than 5 months. Having ruled out other causes of thrombocytopenia, we assume that the case presented was either due to an interaction not elucidated to date or triggered by the grafts (gelatin/collagen/Dacron). The manufacturers of the grafts have disputed a heparinoid action.
Bürger
T
T
Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Medizinische Fakultät der Otto von Guericke-Universität, Leipziger Strasse 44, 39120 Magdeburg, Germany. thomas.buerger@medizin.uni-magdeburg.de
Tautenhahn
J
J
Böck
M
M
Fahlke
J
J
Halloul
Z
Z
Lippert
H
H
D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D020099:Coated Materials, Biocompatible; D003094:Collagen; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005780:Gelatin; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control
D020099:Coated Materials, Biocompatible; D011093:Polyethylene Terephthalates; D005780:Gelatin; D006493:Heparin; D003094:Collagen