Challenging anticoagulation cases: A case of heparin-induced-thrombocytopenia in the first trimester of pregnancy

Heparin-induced thrombocytopenia in pregnancy is an uncommon phenomenon which rarely occurs in the first trimester. Therapeutic options and duration of therapeutic anticoagulation are varied amongst reported published cases. We report a 41-year-old female with confirmed HIT following anticoagulation with dalteparin for deep vein thrombosis (DVT). She was treated with therapeutic fondaparinux for 3 months followed by prophylaxis dosage until delivery and for 6 weeks thereafter. A review of reported cases of the development of HIT in the first trimester and subsequent clinical management is discussed. •Heparin-induced thrombocytopenia (HIT) in pregnancy, especially in the first trimester, is uncommon•Fondaparinux is a reasonable anticoagulation option for HIT in pregnancy•Duration of therapeutic anticoagulation for provoked emboli in pregnancy is unclear•Involvement of a tertiary center for anticoagulation and obstetrical management for pregnant patients with HIT is recommended