title: Unusual complication of heparin-induced thrombocytopenia after mitral valve surgery: spontaneous rupture of spleen.
abstract: A 64-year-old man presented with cardiac tamponade 2 weeks after mitral valve surgery. The patient was anticoagulated for persistent atrial fibrillation after cardiac surgery. A pericardial catheter was placed. Five days after presentation the patient was started on intravenous heparin infusion. The patient had abdominal pain and hypotension develop. A splenic hematoma was diagnosed and a splenectomy was performed. Pathology showed multiple fibrin thrombi in the spleen. The heparin-associated antibodies were detected. Heparin-induced thrombocytopenia is a potentially fatal condition in patients requiring heparin after cardiac surgery. Evaluation for heparin-associated antibodies in these patients may be warranted before heparin therapy.
authors.affiliation: Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Mitchell
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Riley
authors.forename: Bobbak
authors.initials: B
authors.lastname: Vahid
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000209:etiology; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012422:Rupture, Spontaneous; D013156:Splenectomy; D013158:Splenic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013921:Thrombocytopenia / Q000139:chemically induced*; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D006493:Heparin