RSS-Feed abonnieren
DOI: 10.1055/s-0035-1558464
A Case of Heparin-Induced Thrombocytopenia Type 2 after Repair of Juxtarenal Abdominal Aortic Aneurysm
Publikationsverlauf
Publikationsdatum:
14. August 2015 (online)
![](https://www.thieme-connect.de/media/ija/201605/lookinside/thumbnails/10-1055-s-0035-1558464_150012-1.jpg)
Abstract
Heparin-induced thrombocytopenia (HIT) is still a relatively uncommon condition and it is not well known how to administer argatroban during continuous hemodiafiltration (CHDF). A 72-year-old man required CHDF with heparin because of the oliguria and hyperpotassemia directly after the open repair of a juxtarenal abdominal aortic aneurysm. As the postoperative blood platelet count dropped and there was a thrombus in the CHDF circuit, HIT was suspected and nafamostat mesilate, but not heparin, was immediately administered for CHDF. As heparin-platelet factor 4 complex was positive, we diagnosed him with HIT and started argatroban while monitoring the activated clotting time (ACT), resulting in no further obstruction of the CHDF and an increase in the platelets. There was no disadvantage for administering nafamostat mesilate which we have commonly used instead of heparin, we should have used argatroban once we suspected HIT. It may be important to consider the history of heparin especially in administering heparin and it may be useful to monitor the ACT when initially starting argatroban for patients with HIT.
-
References
- 1 Warkentin TE, Greinacher A, Koster A, Lincoff AM ; American College of Chest Physicians. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6, Suppl): 340S-380S
- 2 Girolami B, Girolami A. Heparin-induced thrombocytopenia: a review. Semin Thromb Hemost 2006; 32 (8) 803-809
- 3 Warkentin TE, Levine MN, Hirsh J , et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332 (20) 1330-1335
- 4 Warkentin TE, Kelton JG. Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med 2001; 344 (17) 1286-1292
- 5 van Sambeek MR, Segeren CM, van Dijk LC, van Essen JA, Dippel DW, van Urk H. Endovascular repair of an extracranial internal carotid artery aneurysm complicated by heparin-induced thrombocytopenia and thrombosis. J Endovasc Ther 2000; 7 (5) 353-358
- 6 Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (3, Suppl): 311S-337S
- 7 Miyata S, Yamamoto H. The treatment of heparin-induced thrombocytopenia (HIT) [in Japanese]. Jpn J Thromb Hemost 2008; 19 (2) 195-198
- 8 Kelton JG, Warkentin TE. Heparin-induced thrombocytopenia: a historical perspective. Blood 2008; 112 (7) 2607-2616
- 9 Pötzsch B, Klövekorn WP, Madlener K. Use of heparin during cardiopulmonary bypass in patients with a history of heparin-induced thrombocytopenia. N Engl J Med 2000; 343 (7) 515