PMID- 26538127
OWN - NLM
STAT- MEDLINE
DCOM- 20160913
LR  - 20201209
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2015
DP  - 2015 Nov 4
TI  - Early recognition is the key to success: pulseless electrical activity (PEA) as a 
      manifestation of heparin-induced anaphylactoid reaction.
LID - 10.1136/bcr-2015-210828 [doi]
LID - bcr2015210828
AB  - A 64-year-old man underwent mitral valve replacement. He was hospitalised 9 days 
      later because of slurring of speech and left-sided facial weakness. During 
      hospitalisation, unfractionated heparin (UFH) bolus and drip were initiated due 
      to subtherapeutic international normalised ratio. Within 5 min of UFH bolus, the 
      patient began to experience symptoms of dyspnoea, followed by pulseless 
      electrical activity arrest. He was successfully resuscitated. A decline in 
      platelet count >50% was noted immediately after UFH bolus and cardiac arrest. A 
      diagnosis of heparin-induced thrombocytopenia and anaphylactoid reaction was 
      considered (4Ts score of 7). Heparin was discontinued and argatroban was started. 
      A platelet factor 4 (PF4) assay was strongly positive. Platelet counts 
      subsequently improved following discontinuation of heparin.
CI  - 2015 BMJ Publishing Group Ltd.
FAU - Jayarangaiah, Apoorva
AU  - Jayarangaiah A
AD  - Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA.
FAU - Epperla, Narendranath
AU  - Epperla N
AD  - Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, 
      Wisconsin, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20151104
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Anticoagulants)
RN  - 0 (Pipecolic Acids)
RN  - 0 (Sulfonamides)
RN  - 9005-49-6 (Heparin)
RN  - 94ZLA3W45F (Arginine)
RN  - IY90U61Z3S (argatroban)
SB  - IM
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Arginine/analogs & derivatives
MH  - Arrhythmias, Cardiac/*chemically induced/drug therapy
MH  - Cardiopulmonary Resuscitation
MH  - Early Diagnosis
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Heparin/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Pipecolic Acids/*administration & dosage
MH  - Platelet Count
MH  - Platelet Function Tests/methods
MH  - Sulfonamides
MH  - Thrombocytopenia/*chemically induced/diagnosis/drug therapy
MH  - Treatment Outcome
PMC - PMC4654208
EDAT- 2015/11/06 06:00
MHDA- 2016/09/14 06:00
PMCR- 2017/11/04
CRDT- 2015/11/06 06:00
PHST- 2015/11/06 06:00 [entrez]
PHST- 2015/11/06 06:00 [pubmed]
PHST- 2016/09/14 06:00 [medline]
PHST- 2017/11/04 00:00 [pmc-release]
AID - bcr-2015-210828 [pii]
AID - 10.1136/bcr-2015-210828 [doi]
PST - epublish
SO  - BMJ Case Rep. 2015 Nov 4;2015:bcr2015210828. doi: 10.1136/bcr-2015-210828.