Early-onset heparin-induced thrombocytopenia after a 165-day heparin-free interval: case report and review of the literature.
Early- or abrupt-onset immune-mediated heparin-induced thrombocytopenia (HIT) is defined as HIT that occurs less than 5 days after exposure to heparin in patients who have received heparin within the previous 100 days. We identified no reports in the literature of early-onset HIT in patients who had a heparin-free interval longer than 100 days. However, we report a case of early-onset immune-mediated HIT illustrated by a positive HIT result with serotonin release and enzyme-linked immunosorbent assays, and a decrease in platelet count to less than 100 x 10(3)/mm3 with no evidence of thrombosis, approximately 165 days after the patient's last exposure to heparin. We conclude that clinicians should choose alternative forms of anticoagulation in patients with even a remote history of HIT. If clinicians are compelled to reexpose patients to heparin, they should confirm a negative HIT assay result, monitor for clinical signs of HIT, and provide appropriate treatment if HIT is suspected.
DeEugenio
Deborah L
DL
Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, PA 19140, USA. ddeeugen@temple.edu
Ruggiero
Nicholas J
NJ
Thomson
Lynda J
LJ
Menajovsky
L Bernardo
LB
Herman
Jay H
JH
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D017984:Enoxaparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D013921:Thrombocytopenia / Q000139:chemically induced*; D013997:Time Factors
D000925:Anticoagulants; D017984:Enoxaparin