title: Multiple embolic events in a patient with heparin induced thrombocytopaenic thrombotic syndrome and mural thrombus.
abstract: This report describes a 55-year-old man admitted for renal colic and found to have an infarcted right kidney, for which he was treated with heparin. Heparinization for this condition was stopped on day 12 when the patient developed pain in his left foot. Heparin-induced thrombocytopaenic thrombotic syndrome was confirmed, and despite treatment with danaparoid and bilateral femoral embolectomy, a left above-knee amputation was required. Echocardiogram showed a sessile mural thrombus in the left ventricle, which was considered a likely embolic source. The preoperative development of acute renal failure delayed recovery and necessitated haemodialysis. Anticoagulation of the patient was complicated; however, warfarin was introduced slowly and with good effect.
authors.affiliation: Intensive Care Unit, Bankstown-Lidcombe Hospital, Sydney, New South Wales.
authors.forename: G
authors.initials: G
authors.lastname: Bennett
authors.forename: M R
authors.initials: MR
authors.lastname: Hanley
mesh_terms: D000671:Amputation, Surgical / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D003085:Colic / Q000175:diagnosis / Q000188:drug therapy; D003131:Combined Modality Therapy; D017548:Echocardiography, Transesophageal; D017128:Embolectomy / Q000379:methods; D004636:Emergency Service, Hospital; D005268:Femoral Vein / Q000601:surgery; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D000925:Anticoagulants; D006493:Heparin