Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery: importance of an early diagnosis and Lepirudin treatment
Heparin-induced thrombocytopenia with thrombosis (HITT) is a rare complication of cardiac surgery with cardiopulmonary bypass. We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Le...
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| Veröffentlicht in: | Blood coagulation & fibrinolysis 2004-03, Vol.15 (2), p.183-185 |
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| container_title | Blood coagulation & fibrinolysis |
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| creator | Paparella, Domenico Galeone, Antonella Micelli, Marina Memmola, Cataldo de Luca Tupputi Schinosa, Luigi |
| description | Heparin-induced thrombocytopenia with thrombosis (HITT) is a rare complication of cardiac surgery with cardiopulmonary bypass. We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Lepirudin administration in the first case. In the second, the presence of an intra-aortic balloon pump delayed HITT recognition, and Lepirudin infusion could not prevent limb amputation. In both cases HITT occurred earlier (< 5 days after heparin exposure) than its usual presentation. |
| doi_str_mv | 10.1097/00001721-200403000-00010 |
| format | Article |
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We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Lepirudin administration in the first case. In the second, the presence of an intra-aortic balloon pump delayed HITT recognition, and Lepirudin infusion could not prevent limb amputation. In both cases HITT occurred earlier (< 5 days after heparin exposure) than its usual presentation.</description><identifier>ISSN: 0957-5235</identifier><identifier>EISSN: 1473-5733</identifier><identifier>DOI: 10.1097/00001721-200403000-00010</identifier><identifier>PMID: 15091006</identifier><language>eng</language><publisher>Philadelphia, PA: Lippincott Williams & Wilkins, Inc</publisher><subject>Adult ; Aged ; Amputation ; Aneurysm, Dissecting - etiology ; Aneurysm, Dissecting - surgery ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; Aorta - surgery ; Aortic Aneurysm - etiology ; Aortic Aneurysm - surgery ; Aortic Valve ; Biological and medical sciences ; Blood coagulation. Blood cells ; Blood Vessel Prosthesis Implantation ; Combined Modality Therapy ; Coronary Artery Bypass ; Early Diagnosis ; Fibrinolytic Agents - therapeutic use ; Fundamental and applied biological sciences. Psychology ; Heart Valve Prosthesis Implantation ; Hematologic and hematopoietic diseases ; Heparin - adverse effects ; Heparin - therapeutic use ; Hirudins - analogs & derivatives ; Humans ; Intra-Aortic Balloon Pumping ; Ischemia - drug therapy ; Ischemia - etiology ; Ischemia - surgery ; Leg - blood supply ; Male ; Marfan Syndrome - complications ; Medical sciences ; Mitral Valve - surgery ; Molecular and cellular biology ; Platelet diseases and coagulopathies ; Postoperative Complications - chemically induced ; Recombinant Proteins - therapeutic use ; Thrombocytopenia - chemically induced ; Thrombocytopenia - diagnosis ; Thrombocytopenia - drug therapy ; Thrombophlebitis - drug therapy ; Thrombophlebitis - etiology</subject><ispartof>Blood coagulation & fibrinolysis, 2004-03, Vol.15 (2), p.183-185</ispartof><rights>2004 Lippincott Williams & Wilkins, Inc.</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3310-bf9572b863505eb0d4c12a1064bf77077f5200038905f272f350f768809b32823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15554955$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15091006$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Paparella, Domenico</creatorcontrib><creatorcontrib>Galeone, Antonella</creatorcontrib><creatorcontrib>Micelli, Marina</creatorcontrib><creatorcontrib>Memmola, Cataldo</creatorcontrib><creatorcontrib>de Luca Tupputi Schinosa, Luigi</creatorcontrib><title>Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery: importance of an early diagnosis and Lepirudin treatment</title><title>Blood coagulation & fibrinolysis</title><addtitle>Blood Coagul Fibrinolysis</addtitle><description>Heparin-induced thrombocytopenia with thrombosis (HITT) is a rare complication of cardiac surgery with cardiopulmonary bypass. We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Lepirudin administration in the first case. In the second, the presence of an intra-aortic balloon pump delayed HITT recognition, and Lepirudin infusion could not prevent limb amputation. In both cases HITT occurred earlier (< 5 days after heparin exposure) than its usual presentation.</description><subject>Adult</subject><subject>Aged</subject><subject>Amputation</subject><subject>Aneurysm, Dissecting - etiology</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulants - therapeutic use</subject><subject>Aorta - surgery</subject><subject>Aortic Aneurysm - etiology</subject><subject>Aortic Aneurysm - surgery</subject><subject>Aortic Valve</subject><subject>Biological and medical sciences</subject><subject>Blood coagulation. Blood cells</subject><subject>Blood Vessel Prosthesis Implantation</subject><subject>Combined Modality Therapy</subject><subject>Coronary Artery Bypass</subject><subject>Early Diagnosis</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Heart Valve Prosthesis Implantation</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Heparin - adverse effects</subject><subject>Heparin - therapeutic use</subject><subject>Hirudins - analogs & derivatives</subject><subject>Humans</subject><subject>Intra-Aortic Balloon Pumping</subject><subject>Ischemia - drug therapy</subject><subject>Ischemia - etiology</subject><subject>Ischemia - surgery</subject><subject>Leg - blood supply</subject><subject>Male</subject><subject>Marfan Syndrome - complications</subject><subject>Medical sciences</subject><subject>Mitral Valve - surgery</subject><subject>Molecular and cellular biology</subject><subject>Platelet diseases and coagulopathies</subject><subject>Postoperative Complications - chemically induced</subject><subject>Recombinant Proteins - therapeutic use</subject><subject>Thrombocytopenia - chemically induced</subject><subject>Thrombocytopenia - diagnosis</subject><subject>Thrombocytopenia - drug therapy</subject><subject>Thrombophlebitis - drug therapy</subject><subject>Thrombophlebitis - etiology</subject><issn>0957-5235</issn><issn>1473-5733</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctOxCAUhonR6Hh5BcPGZfUAZWjdGTNekknc6LqhLThoSxugmfQ1fGLpXNSNbAiH7z_kfCCECVwTyMUNxEUEJQkFSIHFUzJV4ADNSCpYwgVjh2gGORcJp4yfoFPvPyLC0kwcoxPCIScA8xn6WkjXjLizXgXcabxSvXTGJsbWQ6VqHFaua8uuGkPXK2skXpuw2le98VjqoByeLmNWuoD94N6VG2-xafvOBWkrNTWWFqvNU7WR73YbtTVeqt64oTYWB6dkaJUN5-hIy8ari91-ht4eFq_3T8ny5fH5_m6ZVIwRSEodp6NlNmccuCqhTitCJYF5WmohQAjN6TRxlgPXVFAdOS3mWQZ5yWhG2RnKtn0r13nvlC56Z1rpxoJAMWku9pqLH83FRnOMXm6j_VC2qv4N7rxG4GoHSF_JRruowfg_HOdpznnk0i237pro0X82w1q5Ippswqr475vZNz1wlkk</recordid><startdate>200403</startdate><enddate>200403</enddate><creator>Paparella, Domenico</creator><creator>Galeone, Antonella</creator><creator>Micelli, Marina</creator><creator>Memmola, Cataldo</creator><creator>de Luca Tupputi Schinosa, Luigi</creator><general>Lippincott Williams & Wilkins, Inc</general><general>The Scientist</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>200403</creationdate><title>Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery: importance of an early diagnosis and Lepirudin treatment</title><author>Paparella, Domenico ; Galeone, Antonella ; Micelli, Marina ; Memmola, Cataldo ; de Luca Tupputi Schinosa, Luigi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3310-bf9572b863505eb0d4c12a1064bf77077f5200038905f272f350f768809b32823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Amputation</topic><topic>Aneurysm, Dissecting - etiology</topic><topic>Aneurysm, Dissecting - surgery</topic><topic>Anticoagulants - adverse effects</topic><topic>Anticoagulants - therapeutic use</topic><topic>Aorta - surgery</topic><topic>Aortic Aneurysm - etiology</topic><topic>Aortic Aneurysm - surgery</topic><topic>Aortic Valve</topic><topic>Biological and medical sciences</topic><topic>Blood coagulation. Blood cells</topic><topic>Blood Vessel Prosthesis Implantation</topic><topic>Combined Modality Therapy</topic><topic>Coronary Artery Bypass</topic><topic>Early Diagnosis</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Heart Valve Prosthesis Implantation</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Heparin - adverse effects</topic><topic>Heparin - therapeutic use</topic><topic>Hirudins - analogs & derivatives</topic><topic>Humans</topic><topic>Intra-Aortic Balloon Pumping</topic><topic>Ischemia - drug therapy</topic><topic>Ischemia - etiology</topic><topic>Ischemia - surgery</topic><topic>Leg - blood supply</topic><topic>Male</topic><topic>Marfan Syndrome - complications</topic><topic>Medical sciences</topic><topic>Mitral Valve - surgery</topic><topic>Molecular and cellular biology</topic><topic>Platelet diseases and coagulopathies</topic><topic>Postoperative Complications - chemically induced</topic><topic>Recombinant Proteins - therapeutic use</topic><topic>Thrombocytopenia - chemically induced</topic><topic>Thrombocytopenia - diagnosis</topic><topic>Thrombocytopenia - drug therapy</topic><topic>Thrombophlebitis - drug therapy</topic><topic>Thrombophlebitis - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Paparella, Domenico</creatorcontrib><creatorcontrib>Galeone, Antonella</creatorcontrib><creatorcontrib>Micelli, Marina</creatorcontrib><creatorcontrib>Memmola, Cataldo</creatorcontrib><creatorcontrib>de Luca Tupputi Schinosa, Luigi</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Blood coagulation & fibrinolysis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Paparella, Domenico</au><au>Galeone, Antonella</au><au>Micelli, Marina</au><au>Memmola, Cataldo</au><au>de Luca Tupputi Schinosa, Luigi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery: importance of an early diagnosis and Lepirudin treatment</atitle><jtitle>Blood coagulation & fibrinolysis</jtitle><addtitle>Blood Coagul Fibrinolysis</addtitle><date>2004-03</date><risdate>2004</risdate><volume>15</volume><issue>2</issue><spage>183</spage><epage>185</epage><pages>183-185</pages><issn>0957-5235</issn><eissn>1473-5733</eissn><abstract>Heparin-induced thrombocytopenia with thrombosis (HITT) is a rare complication of cardiac surgery with cardiopulmonary bypass. We report two cases of HITT treated with the direct thrombin inhibitor Lepirudin. Immediate diagnosis was essential to prompt heparin discontinuation and successful early Lepirudin administration in the first case. In the second, the presence of an intra-aortic balloon pump delayed HITT recognition, and Lepirudin infusion could not prevent limb amputation. In both cases HITT occurred earlier (< 5 days after heparin exposure) than its usual presentation.</abstract><cop>Philadelphia, PA</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>15091006</pmid><doi>10.1097/00001721-200403000-00010</doi><tpages>3</tpages></addata></record> |
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| subjects | Adult Aged Amputation Aneurysm, Dissecting - etiology Aneurysm, Dissecting - surgery Anticoagulants - adverse effects Anticoagulants - therapeutic use Aorta - surgery Aortic Aneurysm - etiology Aortic Aneurysm - surgery Aortic Valve Biological and medical sciences Blood coagulation. Blood cells Blood Vessel Prosthesis Implantation Combined Modality Therapy Coronary Artery Bypass Early Diagnosis Fibrinolytic Agents - therapeutic use Fundamental and applied biological sciences. Psychology Heart Valve Prosthesis Implantation Hematologic and hematopoietic diseases Heparin - adverse effects Heparin - therapeutic use Hirudins - analogs & derivatives Humans Intra-Aortic Balloon Pumping Ischemia - drug therapy Ischemia - etiology Ischemia - surgery Leg - blood supply Male Marfan Syndrome - complications Medical sciences Mitral Valve - surgery Molecular and cellular biology Platelet diseases and coagulopathies Postoperative Complications - chemically induced Recombinant Proteins - therapeutic use Thrombocytopenia - chemically induced Thrombocytopenia - diagnosis Thrombocytopenia - drug therapy Thrombophlebitis - drug therapy Thrombophlebitis - etiology |
| title | Early onset of heparin-induced thrombocytopenia with thrombosis after open heart surgery: importance of an early diagnosis and Lepirudin treatment |
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