Heparin-induced thrombocytopenia presenting as unilateral lower limb paralysis following lumbar spine surgery: case report.
Heparin-induced thrombocytopenia (HIT) is a state of thrombocytopenia with a paradoxically elevated thrombotic potential after exposure to heparin. Severe cases can present with multiorgan involvement with direct and secondary effects. Although HIT has been reported following other surgeries, to the authors' knowledge there has not been a report of HIT after spinal surgery. The present case details the course of a patient who underwent elective lumbar surgery followed by delayed presentation of shortness of breath due to multiple pulmonary embolisms and right lower-extremity paralysis due to extensive iliofemoral clot burden with acute compartment syndrome. The patient was treated with intravenous argatroban for extensive thrombosis and also required open thrombectomy and fasciotomies for treatment of compartment syndrome. Although the patient eventually experienced motor recovery, residual sensory deficits persisted at last follow-up. In this report, the pathophysiology, clinical presentation, and treatment of HIT are reviewed.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Brandon W
BW
Smith
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Jacob R
JR
Joseph
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Paul
P
Park
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001416:Back Pain / Q000601:surgery; D059350:Chronic Pain / Q000601:surgery; D017558:Elective Surgical Procedures / Q000009:adverse effects; D007839:Functional Laterality; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy
D000925:Anticoagulants; D006493:Heparin
DVT = deep venous thrombosis; HIT = heparin-induced thrombocytopenia; PE = pulmonary embolism; POD = postoperative day; complication; heparin-induced thrombocytopenia; lumbar spine; spinal surgery