Heparin-induced thrombocytopenia in the emergency department.
We describe 3 patients who presented to the emergency department (ED) with stroke, deep venous thrombosis, or pulmonary embolism and renal failure after undergoing cardiac surgery 7 to 17 days earlier. Their onset of thrombosis after previous heparin exposure was temporally plausible for complications of heparin-induced thrombocytopenia, an immune-mediated thrombotic disorder triggered by heparin. The patients had normal platelet counts at presentation, yet each had circulating heparin-induced thrombocytopenia antibodies that were ultimately confirmed. Two patients had heparin reexposure in the ED, 1 of whom developed thrombocytopenia with new thrombosis and died. Alternative parenteral anticoagulation prevented further thrombosis in 2 patients. Because heparin use can be catastrophic in patients with heparin-induced thrombocytopenia, physicians should be vigilant in suspecting heparin-induced thrombocytopenia in patients with thrombosis after recent hospitalization or heparin exposure. Alternative anticoagulants are available for these at-risk patients.
Levine
Robert L
RL
University of Texas Health Science Center, Houston, TX 77030, USA. rlevine@uth.tmc.edu
Hursting
Marcie J
MJ
Drexler
Alane
A
Lewis
Bruce E
BE
Francis
John L
JL
D000368:Aged; D000906:Antibodies / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010978:Platelet Factor 4 / Q000276:immunology; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D013923:Thromboembolism / Q000175:diagnosis / Q000188:drug therapy; D013997:Time Factors; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy
D000906:Antibodies; D010978:Platelet Factor 4; D006493:Heparin