title: Early recognition is the key to success: pulseless electrical activity (PEA) as a manifestation of heparin-induced anaphylactoid reaction.
abstract: A 64-year-old man underwent mitral valve replacement. He was hospitalised 9 days later because of slurring of speech and left-sided facial weakness. During hospitalisation, unfractionated heparin (UFH) bolus and drip were initiated due to subtherapeutic international normalised ratio. Within 5 min of UFH bolus, the patient began to experience symptoms of dyspnoea, followed by pulseless electrical activity arrest. He was successfully resuscitated. A decline in platelet count >50% was noted immediately after UFH bolus and cardiac arrest. A diagnosis of heparin-induced thrombocytopenia and anaphylactoid reaction was considered (4Ts score of 7). Heparin was discontinued and argatroban was started. A platelet factor 4 (PF4) assay was strongly positive. Platelet counts subsequently improved following discontinuation of heparin.
authors.affiliation: Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA.
authors.forename: Apoorva
authors.initials: A
authors.lastname: Jayarangaiah
authors.affiliation: Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Narendranath
authors.initials: N
authors.lastname: Epperla
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001120:Arginine / Q000031:analogs & derivatives; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000188:drug therapy; D016887:Cardiopulmonary Resuscitation; D042241:Early Diagnosis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010875:Pipecolic Acids / Q000008:administration & dosage*; D010976:Platelet Count; D010979:Platelet Function Tests / Q000379:methods; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban