Acute pulmonary thromboembolism induced by prophylactic heparin use and a heparin-coated catheter: a case of heparin-induced thrombocytopenia and thrombosis syndrome.
Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) is a potentially life-threatening side effect of heparin therapy, triggered by an immune response, and has been reported to be related not only to the therapeutic use of heparin but also to heparin-coated catheters. A 45-year-old woman with intrapelvic malignancy developed an acute pulmonary thromboembolism (PE) after hysterectomy despite prophylactic heparin use. Subsequent large doses of heparin for treatment of the PE exacerbated the thrombocytopenia and, moreover, a large thrombus formed around the heparin-coated central venous catheter. Anti-heparin-platelet factor 4 complex antibody and heparin-induced platelet aggregation assay were positive, so the diagnosis was HITTS, and heparin was replaced by argatroban after carrying out thrombectomy. This therapy was successful, and the patient made favorable progress.
Nasuno
Akimitsu
A
First Department of Internal Medicine, Niigata University Medical Hospital, Japan.
Matsubara
Taku
T
Hori
Tomoyuki
T
Higuchi
Kotaro
K
Tsuchida
Keiichi
K
Mezaki
Tohru
T
Tanaka
Takayuki
T
Hanzawa
Kazuhiro
K
Moro
Hisanaga
H
Hayashi
Jun-ichi
J
Tanaka
Ken-ichi
K
Fuse
Ichiro
I
Aizawa
Yoshifusa
Y
D000208:Acute Disease; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives; D002404:Catheterization / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D020099:Coated Materials, Biocompatible / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D010875:Pipecolic Acids / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology / Q000517:prevention & control; D011877:Radionuclide Imaging; D013449:Sulfonamides; D013577:Syndrome; D013921:Thrombocytopenia / Q000139:chemically induced*; D013923:Thromboembolism / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban