Eur J Cardiothorac Surg 1999;15:874-875
© 1999 Elsevier Science NL
Images in cardio-thoracic surgery |
Clinical manifestation of heparin-induced thrombocytopenia type II
Andreas Koster,
Mathias Bauer,
Miralem Pasic,
Roland Hetzer
Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D 13353 Berlin, Germany
Received 11 November 1998;
accepted 11 March 1999.
Corresponding author. Tel.: +49 30 4593 2600; fax:+49 30 4593 2700
e-mail: ankoster{at}t-online.de
An 80-year-old female with postinfarction ventricular septal defect was transferred to our institution. She had been anticoagulated with unfractioned heparins for 3 days since the infarction occurred. Forty-two hours after admission the patient developed a thrombosis in the left forearm (Fig. 1)
and embolization in the front of her right foot (Fig. 2)
. A platelet count revealed a decrease from 1193/ml to 143/ml. Heparin-induced thrombocytopenia, type II (HIT II), was suspected and anticoagulation was immediately changed to r-hirudin. Laboratory investigation of the heparin/platelet factor 4 ELISA and heparin-induced platelet aggregation assay (HIPAA) confirmed the diagnosis of HIT II. The platelet count increased during therapy with r-hirudin to 1503/ml within 2 days. Because of hemodynamic deterioration, the postinfarctional VSD was closed with a Dacron patch and the left anterior descending artery revascularized with a venous graft. The anticoagulation during cardiopulmonary bypass was performed with r-hirudin and monitored by measurement of the ecarin clotting time. The immediate postoperative course of the patient was uneventful.
