title: [Thrombocytopenia associated with massive cardiac thrombosis during treatment with non-fractionated heparin: description of a clinical case].
abstract: 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.
authors.affiliation: U.O. di Cardiologia, Ospedale Civile Umberto I, Mestre, VE. depiccoli@inwind.it
authors.forename: Bruno
authors.initials: B
authors.lastname: De Piccoli
authors.forename: Anna
authors.initials: A
authors.lastname: Martino
authors.forename: Guerrino
authors.initials: G
authors.lastname: Zuin
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
mesh_terms: 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*
chemical_list: D006493:Heparin