title: [Heparin-induced thrombocytopenia and liver hemorrhage following polytrauma].
abstract: Up to 3% of patients receiving unfractioned heparin develop heparin-induced thrombocytopenia (HIT). We report on a polytrauma patient who developed severe HIT with bilateral pulmonary embolism. Lepirudin treatment resulted initially in rapid improvement. Ten days after discharge the patient complained of abdominal pain. A large subcapsular hepatic hematoma was diagnosed, requiring repeat surgery and ending in secondary sclerosing cholangitis. This process can potentially be avoided by regular tests of lepirudin concentration and coagulation.
authors.affiliation: Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover. manoliodakis@yahoo.gr
authors.forename: E
authors.initials: E
authors.lastname: Liodakis
authors.forename: F
authors.initials: F
authors.lastname: Hildebrand
authors.forename: M
authors.initials: M
authors.lastname: Frink
authors.forename: P
authors.initials: P
authors.lastname: Mommsen
authors.forename: C
authors.initials: C
authors.lastname: Krettek
authors.forename: C
authors.initials: C
authors.lastname: Probst
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001019:Aortic Rupture / Q000601:surgery; D001780:Blood Coagulation Tests; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006549:Hernia, Diaphragmatic, Traumatic / Q000601:surgery; D006629:Hirudins / Q000009:adverse effects; D006801:Humans; D008099:Liver / Q000293:injuries / Q000601:surgery; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000601:surgery*; D010359:Patient Readmission; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012086:Reoperation; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced*; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin