PMID- 31133634
OWN - NLM
STAT- MEDLINE
DCOM- 20191230
LR  - 20200225
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 20
DP  - 2019 May 28
TI  - Missed Heparin-Induced Thrombocytopenia (HIT) Diagnosis in a Patient with Acute 
      Stent Thrombosis.
PG  - 753-757
LID - 10.12659/AJCR.914988 [doi]
AB  - BACKGROUND Heparin-induced thrombocytopenia (HIT) is a serious complication of 
      heparin therapy, characterized by thrombocytopenia and high risk for venous and 
      arterial thrombosis. CASE REPORT We report an unusual case of acute stent 
      thrombosis secondary to delayed HIT. A 74-year-old man with non-ST-segment 
      elevation myocardial infarction had a coronary angiography which revealed 
      2-vessel disease. A bolus of unfractionated heparin (UFH) was administered at 
      admission and he received fondaparinux during his hospitalization. We performed 
      elective percutaneous coronary intervention (PCI) with stents to LAD and LCx. Two 
      hours after PCI, the patient developed acute pulmonary edema, and repeat 
      angiography revealed an occlusive thrombus in the ostial LAD and the LCx. A 
      turbidimetric assay for the rapid detection of plasma anti-PF4/heparin antibodies 
      was negative. After repeated unsuccessful attempts of balloon angioplasty and 
      continuous thrombosis, the patient was transferred for emergency surgical 
      revascularisation and was treated with additional UFH followed by enoxaparin. 
      Platelets decreased gradually to 38 k/mul 7 days after surgery, at which time 
      enoxaparin was replaced with fondaparinux. The subsequent HIT test results were 
      positive. CONCLUSIONS HIT should be considered in patients with multiple recent 
      exposures to anticoagulants, independent of the platelet count, if there are 
      signs and symptoms of thrombosis.
FAU - Voudris, Vassilis
AU  - Voudris V
AD  - Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, 
      Greece.
FAU - Georgiadou, Panagiota
AU  - Georgiadou P
AD  - Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, 
      Greece.
FAU - Kalogris, Panagiotis
AU  - Kalogris P
AD  - Division of Cardiothoracic Surgery, Onassis Cardiac Surgery Center, Athens, 
      Greece.
FAU - Kostelidou, Theodora
AU  - Kostelidou T
AD  - Division of Thrombosis and Hemostasis, Onassis Cardiac Surgery Center, Athens, 
      Greece.
FAU - Karabinis, Andreas
AU  - Karabinis A
AD  - Department of Intensive Care, Onassis Cardiac Surgery Center, Athens, Greece.
FAU - Gerotziafas, Grigorios
AU  - Gerotziafas G
AD  - Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, INSERM U938, 
      Institut Universitaire de Cancerologie (IUC), Pierre and Marie Curie University 
      (UPMC) Faculty of Medicine, Sorbonne Universites, Paris, France.
AD  - Biological Hematology Service Tenon Hospital, University Hospital Est Parisien, 
      Assistance Publique Hopitaux de Paris, Paris, France.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20190528
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*adverse effects
MH  - Coronary Artery Disease/therapy
MH  - Enoxaparin/adverse effects
MH  - Heparin/*adverse effects
MH  - Humans
MH  - Male
MH  - Percutaneous Coronary Intervention/adverse effects
MH  - Stents/*adverse effects
MH  - Thrombocytopenia/*chemically induced/*diagnosis
MH  - Thrombosis/diagnosis/*etiology/therapy
PMC - PMC6558115
COIS- Conflict of interest: None declared Conflict of interest None.
EDAT- 2019/05/28 06:00
MHDA- 2019/12/31 06:00
PMCR- 2019/05/28
CRDT- 2019/05/29 06:00
PHST- 2019/05/29 06:00 [entrez]
PHST- 2019/05/28 06:00 [pubmed]
PHST- 2019/12/31 06:00 [medline]
PHST- 2019/05/28 00:00 [pmc-release]
AID - 914988 [pii]
AID - 10.12659/AJCR.914988 [doi]
PST - epublish
SO  - Am J Case Rep. 2019 May 28;20:753-757. doi: 10.12659/AJCR.914988.