Off-pump right atrial thrombectomy for heparin-induced thrombocytopenia with thrombosis.
This report describes a 72-year-old woman with atrial fibrillation who presented with lower extremity ischemia secondary to thromboembolism. After lower extremity thrombectomy, the patient developed heparin-induced thrombocytopenia with thrombosis (HITT). Her postoperative course was complicated by recurrent supraventricular and ventricular tachycardia, secondary to a mobile thrombus in the right atrium extending into the right ventricle. Because administration of heparin was contraindicated, the patient underwent off-pump right atrial thrombectomy during a brief period of inflow occlusion. Postoperatively, she was placed on lepirudin. Her platelet count normalized without any further thrombotic episodes, and she was discharged on warfarin.
Morgan
Jeffrey A
JA
Division of Cardiothoracic Surgery, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. jm2240@columbia.edu
Kherani
Aftab R
AR
Vigilance
Deon W
DW
Cheema
Faisal H
FH
Colletti
Nicholas J
NJ
Sahar
David I
DI
Jan
Kung Ming
KM
Diuguid
David L
DL
Nowygrod
Roman
R
Oz
Mehmet C
MC
Argenziano
Michael
M
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D035002:Lower Extremity; D011184:Postoperative Period; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment; D017131:Thrombectomy / Q000379:methods*; D013921:Thrombocytopenia / Q000139:chemically induced*; D013923:Thromboembolism / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin