title: Treatment of heparin-induced thrombocytopenia with drotrecogin alfa (activated).
abstract: A patient was administered drotrecogin alfa (activated) in addition to the standard of care for presumed severe sepsis and circulatory shock. Heparin-induced thrombocytopenia (HIT) and hepatic and splenic thromboses complicated her clinical course. Because drotrecogin alfa (activated) treatment is associated with improvement in thrombotic manifestations and thrombocytopenia, it was continued as the sole antithrombotic agent after the HIT became apparent. This approach was chosen despite the patient's severe hepatic and renal dysfunction, which made the use of direct thrombin inhibitors unfavorable. She survived with a reasonable outcome and salvage of her limbs. Although this case suggests a potential role of drotrecogin alfa (activated) in the management of HIT, systematic evaluation of its efficacy in this situation is warranted.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA. grubeiz@ecommunity.com
authors.forename: George J
authors.initials: GJ
authors.lastname: Rubeiz
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Marrone
authors.forename: Jacques R
authors.initials: JR
authors.lastname: Leclerc
mesh_terms: D000906:Antibodies / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D008875:Middle Aged; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy*; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000906:Antibodies; D005343:Fibrinolytic Agents; D011486:Protein C; D011994:Recombinant Proteins; D006493:Heparin; C421124:drotrecogin alfa activated