Heparin-induced thrombocytopenia in a patient with left main coronary artery stenosis

Czech version

Authors: J. Hirmerová
Authors‘ workplace: II. interní klinika Lékařské fakulty UK a FN, Plzeň, přednosta doc. MUDr. Jan Filipovský, CSc.
Published in: Vnitř Lék 2005; 51(2): 231-237
Category: Case Reports

Overview

The article describes a case of a 75 year old female patient with hypertension and chronic atrial fibrillation, admitted for shortness of breath and chest pain. Coronarography revealed a significant stenosis of the left main coronary artery. The patient was indicated to coronary artery bypass grafting. During the stay, low molecular weight heparin had been applied. In the third week the platelet count fell down markedly and several days later, heparin necrosis developed in a place of subcutaneous heparin application in abdominal wall. Laboratory assays confirmed the presence of the antibodies against the heparin/ platelet factor 4 complex. Thus the heparin-induced thrombocytopenia (type II) was diagnosed, the relatively rare complication of heparin therapy, associated with hypercoagulable state. Low molecular weight heparin was quit. Platelet count recovered slowly, heparin necrosis healing took several months. Heparin was considered to be contraindicated, so the cardiac surgery was not feasible. Because of borderline significance of the stenosis conservative approach was chosen. Since discharge, the patient has been followed on outpatient basis and there has been no need to consider the invasive treatment again. The special features of the case are discussed, as well as the diagnostics and treatment of heparin– induced thrombocytopenia and the possibilities of invasive procedure using nonheparin anticoagulant.

Key words:
heparin-induced thrombocytopenia – left main coronary artery stenosis – hypercoagulable state – anticoagulant therapy

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