Abstract
BackgroundDelayed-onset heparin-induced thrombocytopenia with thrombosis, albeit rare, is a severe side effect of heparin exposure. It can occur within one month after coronary artery bypass grafting (CABG) with manifestation of different thrombotic events.Case presentationA 59-year-old man presented with weakness, malaise, bilateral lower limb pitting edema and a suspected diagnosis of deep vein thrombosis 18 days after CABG. Heparin infusion was administered as an anticoagulant. Clinical and paraclinical work-up revealed multiple thrombotic events (stroke, renal failure, deep vein thrombosis, large clots in heart chambers) and 48 ×103/μl platelet count, whereupon heparin-induced thrombocytopenia was suspected. Heparin was discontinued immediately and an alternative anticoagulant agent was administered, as a result of which platelet count recovered. Heparin-induced thrombocytopenia, which causes thrombosis, is a serious side effect of heparin therapy. It is worthy of note that no case of delayed-onset heparin-induced thrombocytopenia with thrombosis associated with cardiopulmonary bypass surgery has thus far been reported in Iran.ConclusionDelayed-onset heparin-induced thrombocytopenia should be suspected in any patient presenting with arterial or venous thromboembolic disorders after recent heparin therapy, even though the heparin exposure dates back to more than a week prior to presentation; and it should be ruled-out before the initiation of heparin therapy.
Highlights
Delayed-onset heparin-induced thrombocytopenia with thrombosis, albeit rare, is a severe side effect of heparin exposure
Delayed-onset heparin-induced thrombocytopenia should be suspected in any patient presenting with arterial or venous thromboembolic disorders after recent heparin therapy, even though the heparin exposure dates back to more than a week prior to presentation; and it should be ruled-out before the initiation of heparin therapy
The incidence of Heparin-induced thrombocytopenia (HIT) in patients who have undergone cardiopulmonary bypass surgery has been estimated at 1.9% [1]
Summary
Delayed-onset HIT should be suspected in any patient presenting with arterial or venous thromboembolic thromboembolic disorders after recent heparin therapy, even though the heparin exposure is more than a week before representation. Delayed-onset HIT should be considered and ruled-out before initiating heparin therapy in this group of patients. A S carried out the surgery, managed postoperative complication, and was directly involved in conception, design and drafting the manuscript. A K and H A gave critical comments on the results and participated in planning and coordination of the study. P Y participated in the design of study, and was directly involved in drafting and revising the manuscript. All Authors read and approved the final manuscript. Written consent was obtained from the patient for publication of this study
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