Acute coronary thrombosis due to heparin-induced thrombocytopenia following improved COVID-19 pneumonia: A case report

A 45-year-old male with anteroseptal myocardial infarction was referred to our hospital. The patient was previously admitted to another hospital with coronavirus disease-2019 pneumonia for 2 weeks; he was discharged 2 weeks before presentation to our institution. He received conventional treatment for coronavirus disease-2019, including administration of heparin. A moderate decrease in platelet count was observed on admission, and emergent angiography was performed under a definitive diagnosis of acute coronary syndrome. The angiography revealed occlusion of the left anterior descending artery. Percutaneous coronary intervention was performed; however, the occlusion did not improve owing to persistent thrombosis in the distal left anterior descending artery. Therefore, we induced intra-aortic balloon pumping to improve coronary blood flow and obtained Thrombolysis in Myocardial Infarction grade 2 flow. Following percutaneous coronary intervention, we detected a further decrease in platelets and positivity for heparin-induced thrombocytopenia antibody, leading to the diagnosis of heparin-induced thrombocytopenia. Subsequently, oral anticoagulation was introduced, and the symptoms did not recur. Treatment with heparin is indicated for patients with coronavirus disease-2019 (COVID-19) because of derangement of the coagulation system. However, this approach contributes to the development of heparin-induced thrombocytopenia (HIT). We report a case of acute coronary syndrome due to HIT with COVID-19. HIT is commonly reported in patients with COVID-19. Thus, attentive monitoring of the platelet count and considering the possibility of HIT are indispensable when treating acute coronary syndrome in patients with previous history of COVID-19.