Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery: importance of an early diagnosis and Lepirudin treatment.
Heparin-induced thrombocytopenia with thrombosis (HITT) is a rare complication of cardiac surgery with cardiopulmonary bypass. We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Lepirudin administration in the first case. In the second, the presence of an intra-aortic balloon pump delayed HITT recognition, and Lepirudin infusion could not prevent limb amputation. In both cases HITT occurred earlier (< 5 days after heparin exposure) than its usual presentation.
Paparella
Domenico
D
Division of Cardiac Surgery and Division of Cardiology, University of Bari, Policlinico of Bari, Italy. paparella@tin.it
Galeone
Antonella
A
Micelli
Marina
M
Memmola
Cataldo
C
de Luca Tupputi Schinosa
Luigi
L
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D000784:Aortic Dissection / Q000209:etiology / Q000601:surgery; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery; D001021:Aortic Valve; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D042241:Early Diagnosis; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019918:Heart Valve Prosthesis Implantation; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006629:Hirudins / Q000031:analogs & derivatives; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007511:Ischemia / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000139:chemically induced*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D013924:Thrombophlebitis / Q000188:drug therapy / Q000209:etiology*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin