Massive Pulmonary Embolism in a Patient with Heparin Induced Thrombocytopenia: Successful Treatment with Dabigatran/Heparin Iliskili Trombositopenili Bir Hastada Masif Pulmoner Emboli: Basarili Dabigatran Uygulamasi

Heparin induced thrombocytopenia (HIT) is a rare, potentially fatal, immune-mediated complication of heparin therapy, associated with thrombosis and thrombocytopenia. In this study, a successful dabigatran administration in a case with massive pulmonary thromboembolism (mPTE) and HIT is presented. 57 years-old female, who was receiving low molecular weight heparin (LMWH) (0.4 mL once a daily, S.C. for 11 days) due to total knee replacement, was referred to our clinic with the hypotension and syncope attacks. Her echocardiography and pulmonary CT angiography findings were consistent with mPTE. We detected a serious decrease in her platelet count highly suggestive for HIT (plt: 54 x [10.sup.3]/[micro]L). LMWH was discontinued and dabigatran was started (150 mg twice daily). After platelet count increased over 150 x [10.sup.3]/[micro]L, dabigatran was switched to warfarin. Since heparin is widely used in medicine, all physicians need to be aware of this life threatening complication of heparin. Replacing heparin with an alternative anticoagulant such as dabigatran may become a life-saving strategy especially in case of HIT complicated with mPTE. Keywords: Dabigatran, heparin, low molecular weight heparin, new oral anticoagulants, pulmonary embolism. Heparin iliskili trombositopeni (HIT), heparin tedavisinin nadir ancak olumcul olabilen immun aracili komplikasyonu olup, tromboz ve trombositopeni ile seyreder. Burada HIT ve masif pulmoner tromboemboli (mPTE) olgusunda basarili Dabigatran (oral trombin inhibitoru) uygulamasi sunulmaktadir. Total diz replasmani nedeniyle profilaktik dusuk molekuler agirlikli heparin (DMAH, 0,4 mL 1x1, S.C., 11 gun) tedavisi altinda olan 57 yasinda kadin hasta hipotansiyon ve senkop yakinmalariyla klinigimize sevk edildi. Ekokardiyografi ve pulmoner BT anjiyografi bulgulari mPTE bulgulari ile uyumlu idi. HIT tanisini dusunduren trombosit sayilarinda belirgin dusme tespit edildi (plt: 54 x [10.sup.3]/[micro]L). Aldigi DMAH ve warfarin tedavisi hemen kesilerek Dabigatran baslandi (2 x 150 mg). Trombosit sayisi 150 x [10.sup.3]/[micro]L uzerine ciktiktan sonra dabigatran warfarin ile degistirildi. Tum hekimler tipta yaygin olarak kullanilan heparinin hayati tehdit eden bu komplikasyonunu akilda tutmalidir. Heparinin dabigatran gibi alternatif bir antikoagulan ile degistirilmesi mPTE ile komplike olmus HIT olgularinda hayat kurtaran bir strateji olabilir. Anahtar Kelimeler: Dabigatran, heparin, dusuk molekuler agirlikli heparin, yeni