title: Delayed-onset severe heparin-induced thrombocytopenia after total arch replacement under cardiopulmonary bypass.
abstract: An extremely rare case with delayed-onset heparin-induced thrombocytopenia (HIT) is described. A 46-year-old man underwent arch replacement for aortic dissection under cardiopulmonary bypass and initial exposure of unfractionated heparin. In post operative 7 days, persistent atrial fibrillation was occurred, so a continuous infusion of heparin (10000 IU/day) and Vitamine K antagonist (Warfarin) taking was started for preventing thrombosis. By 32 days after the operation, his platelet count had fallen (3×10(3)/µL) and oral hematoma and ecchymoma of bilateral lower legs were occurred. The value of HIT antibodies and the IgG antibody was 2.485 and 1.586 on 32-postoperative day, respectively. Heparin was immediately discontinued, and argatroban administrated. Platelet exceeded above 100×10(3)/µL on 12 days of the therapy. To our knowledge, few cases of delayed-onset severe HIT associated with CPB surgery have been reported in Japan.
authors.affiliation: Department of Cardiovascular Surgery, Institute for Health Biosciences, the University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Nakayama
authors.forename: Hajime
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Mikio
authors.initials: M
authors.lastname: Sugano
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kurobe
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kanbara
authors.forename: Eiki
authors.initials: E
authors.lastname: Fujimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitaichi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sogabe
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kitagawa
mesh_terms: D017668:Age of Onset; D000925:Anticoagulants / Q000009:adverse effects*; D001013:Aorta, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy
chemical_list: D000925:Anticoagulants; D006493:Heparin