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Introduction: We report a case of a patient who had a Y-graft replacement after the rupture of abdominal aortic aneurysm (AAA) and developed heparin-induced thrombocytopenia (HIT) with severe consumptive coagulopathy. Case Description: A 67 year-old man was suffering from sudden, severe back pain and was transported to our emergency room. His blood pressure was 104/52 mmHg, heart rate was 90 bpm, alert consciousness with no specific abnormalities during physical examination on arrival. A CT revealed an AAA with a diameter of 90 mm, and hematoma in retroperitoneum suggesting a rupture of AAA. An emergency Y-graft replacement was performed with a blood loss of 12,897 ml during the operation, and then he entered Surgical ICU. Renal replacement therapy was performed on Day 7 for acute kidney injury developed postoperatively. Nafamostat mesilate was administrated as anticoagulant. We found a thrombus in his right internal jugular vein on CT scanned on Day 9, so we started continuous intravenous infusion of heparin as thrombolytic therapy. On the same day, the hemodiafiltration circuit was frequently occuluded by blood clots. The next day, platelets decreased to 74,000 /μL which was a 60% decrease compared to the day before. We considered the possibility of HIT and DIC, and stopped heparin immediately. We then administrated recombinant thrombomodulin (rTM). On Day 11, HIT antibodies were detected in his blood with a strong positive reaction. A clinical diagnosis of HIT was made, and we continuously administered argatroban. However, we had no choice but to decrease the dosage of argatroban and finally stopped it on Day 15 because of prolonged APTT and bleeding tendency. Of course we already stopped administrating rTM. He fell into multiple organ dysfunction syndrome and died on Day 59. Discussion: We think that HIT led to not only hypercoagulability but also consumptive coagulopathy. Fondaparinux could be effective in this case, but its administration is not admitted in Japan. It is necessary to establish a therapy for HIT-associated consumptive coagulopathy.