Severe Thrombocytopenia in a Patient with Submassive Pulmonary Embolism and Heparin-Induced Thrombocytopenia: to Lyse or Not to Lyse?

Abstract

Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction to heparin which can cause life-threatening venous as well as arterial thrombosis. HIT-driven thrombosis is associated with very high morbidity and mortality. Patients with HIT are also at increased risk of bleeding due to concomitant use of non-heparin anticoagulant, especially in patients with profound thrombocytopenia. We present a case of a 69-year-old female who developed heparin-induced thrombocytopenia complicated by acute submassive pulmonary embolism 1 week after total knee replacement surgery. Despite treatment with a direct thrombin inhibitor, her hemodynamic status deteriorated. She was given half-dose (50 mg) systemic thrombolysis resulting in hemodynamic and respiratory status improvement without any bleeding complications. This case represents successful thrombolysis of a submassive pulmonary embolism in a patient with severe thrombocytopenia resulting from heparin-induced thrombocytopenia.