Heparin-induced thrombocytopenia in a case of endovascular aneurysm coiling.
We report a case of 46-year-old man who underwent endovascular coil embolization for left anterior inferior cerebellar and posterior inferior cerebellar aneurysms. During embolization of both aneurysms, thrombotic complications were observed along with a relative lack of response to heparin. Intra-arterial abciximab was used to recanalize an almost completely occluded posterior inferior cerebellar artery. A marked decrease in platelet counts was found soon after embolization, which normalized within a few days. Serologic tests confirmed heparin-induced thrombocytopenia. This syndrome should be considered in cases with thromboembolic complications during endovascular procedures, particularly in patients undergoing repeated heparin exposure. A sudden decrease in platelet counts and lack of response to heparin, manifested as a relative lack of increasing activated clotting time, should make one suspect this syndrome.
Gupta
V
V
Department of Neuroradiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India. vipulgupta25@yahoo.com
Tanvir
R
R
Garg
A
A
Gaikwad
S B
SB
Mishra
N K
NK
D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002533:Cerebral Angiography; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007262:Infusions, Intravenous; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D013921:Thrombocytopenia / Q000139:chemically induced*; D014057:Tomography, X-Ray Computed; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D006493:Heparin