title: Recurrent arterial thromboses in a woman with heparin induced thrombocytopenia, successfully managed with iloprost followed by clopidogrel. An alternative therapeutic option for heparin induced thrombocytopenia type II syndrome.
abstract: In its more severe form heparin induced thrombocytopenia (HIT) is a rare immune mediated complication of heparin administration that potentially has catastrophic results, and significant mortality. In view of the severity of this condition it is important for the clinician to maintain a high index of suspicion and get alerted to the HIT syndrome by the precocity of platelet count decrease in any patient group, and especially in those previously exposed to heparin. We report on a 72-year-old woman who developed HIT syndrome that was complicated by recurrent arterial thromboses after receiving postoperative antithrombotic prophylaxis with tinzaparin, a low molecular weight heparin. The patient was successfully treated with iloprost (Ilomedin, iloprost tromethamine, Schering) a stable prostacyclin analogue, at the acute phase of the syndrome, followed by long-term treatment with clopidogrel (Plavix, clopidogrel bisulfate, Sanofi) an inhibitor of adenosine diphosphate (ADP) receptor. Although direct thrombin inhibitors have been proven to be effective for the treatment of HIT thrombosis, they do not completely eliminate the morbidity and mortality of this disorder. Our case report suggests that antithrombotic treatment by targeting of the activated platelets with a potent platelet inhibitor during the acute phase of type II HIT syndrome followed by long-term administration of oral anticoagulation may be an additional, safe and effective therapeutic alternative that merits to be systematically studied.
authors.affiliation: Fourth Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Megalopoulos
authors.forename: K
authors.initials: K
authors.lastname: Vasiliadis
authors.forename: T
authors.initials: T
authors.lastname: Tsachalis
authors.forename: K
authors.initials: K
authors.lastname: Tsalis
authors.forename: K
authors.initials: K
authors.lastname: Blouhos
authors.forename: S
authors.initials: S
authors.lastname: Alexandridou
authors.forename: D
authors.initials: D
authors.lastname: Betsis
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000188:drug therapy*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D016285:Iloprost / Q000627:therapeutic use*; D007866:Leg / Q000098:blood supply; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography; D012008:Recurrence; D013577:Syndrome; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078222:Tinzaparin
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D000078222:Tinzaparin; D000077144:Clopidogrel; D016285:Iloprost; D013988:Ticlopidine