[Thrombocytopenia associated with massive cardiac thrombosis during treatment with non-fractionated heparin: description of a clinical case].
Thrombosis associated with a drop in the platelet count may occur in 33-50% of the patients who develop heparin-induced thrombocytopenia (HIT) during treatment with unfractionated heparin; the deep veins are commonly involved while cardiac thrombosis is considered as a rare complication. We report the case of a 64-year-old woman who was treated with unfractionated heparin following a myocardial infarction and an episode of deep vein thrombosis which occurred 13 days after myocardial revascularization including triple coronary artery bypass grafting; a drop in the patient's platelet count was documented and a transesophageal echocardiogram revealed massive thrombosis of the four cavities of her heart. The diagnosis of HIT was supported by high blood levels of PF4-antiheparin antibodies. Heparin infusion was stopped and the patient was started on sodium warfarin therapy; the platelet count promptly returned to normal and the size of the clots slowly decreased, although they were still detectable 1 month later. Aspirin (325 mg daily) was then prescribed as an adjunct to warfarin and 6 months later we documented the total disappearance of the thrombotic masses without embolic complications.
De Piccoli
Bruno
B
U.O. di Cardiologia, Ospedale Civile Umberto I, Mestre, VE. depiccoli@inwind.it
Martino
Anna
A
Zuin
Guerrino
G
Raviele
Antonio
A
D005260:Female; D006331:Heart Diseases / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced*; D013927:Thrombosis / Q000139:chemically induced*
D006493:Heparin