Abstract
Thrombosis due to heparin-induced thrombocytopenia (HIT) is rare but has a severe prognosis. Its management is not always easy, particularly in old patients with renal insufficiency. A 95-year-old woman was hospitalized for dyspnea. Curative treatment with unfractionated heparin was started because pulmonary embolism was suspected. Disseminated intravascular coagulation was then suspected because of thrombocytopenia, hypoprothrombinemia, hypofibrinogenemia, and a positive ethanol gelation test. The first immunoassay for HIT was negative. On the 12th day of hospitalization, bilateral cyanosis of the toes occurred associated with recent deep bilateral venous and arterial thrombosis at duplex ultrasound. New biological tests confirmed HIT and led us to stop heparin and to start argatroban with a positive clinical and biological evolution. Venous and arterial thrombosis associated with thrombocytopenia during heparin treatment must be considered HIT whatever the biological test results are. Argatroban is a good alternative treatment in the elderly.
Highlights
Heparin-induced thrombocytopenia (HIT) is an immunemediated syndrome caused by heparin
Venous and arterial thrombosis associated with thrombocytopenia during heparin treatment must be considered heparin-induced thrombocytopenia (HIT) whatever the biological test results are
We report a case of severe HIT associated with arterial and venous thrombosis, bilateral distal necrosis of the lower limbs, and disseminated intravascular coagulation (DIC), successfully treated with argatroban
Summary
Heparin-induced thrombocytopenia (HIT) is an immunemediated syndrome caused by heparin. Complications range from benign thrombocytopenia to severe thrombosis with risk of death. Its management is not always easy, in particular in elderly patients. We report a case of severe HIT associated with arterial and venous thrombosis, bilateral distal necrosis of the lower limbs, and disseminated intravascular coagulation (DIC), successfully treated with argatroban
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