title: A rare and undesirable complication of heparin-induced thrombocytopenia: acute massive pulmonary embolism.
abstract: A 69-year-old woman presented to the emergency department with sudden onset of dyspnea. She reported bilateral total knee surgery 12 days prior for gonarthrosis. The patient was recommended low-molecular-weight heparin (LMWH) 0.4 cc (4 milliliter) twice a day. On evaluation, severe thrombocytopenia was detected. An echocardiogram was performed because of her dyspnea, which revealed right ventricular dilatation and hypokinesis. Due to suspicion of a pulmonary embolism (PE), a pulmonary computed tomography (CT) was performed, which revealed bilateral massive PE. This event occurred while the patient was receiving LMWH for prophylaxis of PE. Due to the presence of severe thrombocytopenia, fondaparinux and immunoglobulin were initiated. Her platelet levels improved significantly and she was discharged on warfarin.
authors.affiliation: Department of Cardiology, Selcuk University, Meram School of Medicine, Konya, Turkey. elvin_salamov@yahoo.com
authors.forename: Enes Elvin
authors.initials: EE
authors.lastname: Gul
authors.forename: Turyan
authors.initials: T
authors.lastname: Abdulhalikov
authors.forename: Ramazan
authors.initials: R
authors.lastname: Aslan
authors.forename: Ismet
authors.initials: I
authors.lastname: Aydogdu
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee; D004452:Echocardiography; D005260:Female; D000077425:Fondaparinux; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D011134:Polysaccharides / Q000008:administration & dosage*; D011655:Pulmonary Embolism / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D007074:Immunoglobulin G; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux