title: Off-pump right atrial thrombectomy for heparin-induced thrombocytopenia with thrombosis.
abstract: 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.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. jm2240@columbia.edu
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Aftab R
authors.initials: AR
authors.lastname: Kherani
authors.forename: Deon W
authors.initials: DW
authors.lastname: Vigilance
authors.forename: Faisal H
authors.initials: FH
authors.lastname: Cheema
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Colletti
authors.forename: David I
authors.initials: DI
authors.lastname: Sahar
authors.forename: Kung Ming
authors.initials: KM
authors.lastname: Jan
authors.forename: David L
authors.initials: DL
authors.lastname: Diuguid
authors.forename: Roman
authors.initials: R
authors.lastname: Nowygrod
authors.forename: Mehmet C
authors.initials: MC
authors.lastname: Oz
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
mesh_terms: 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*
chemical_list: D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin