The Journal of Medical Investigation
Online ISSN : 1349-6867
Print ISSN : 1343-1420
ISSN-L : 1343-1420
Case reports
Delayed-onset severe heparin-induced thrombocytopenia after total arch replacement under cardiopulmonary bypass
Taisuke Nakayama MD, Hajime Kinoshita MD, Mikio Sugano MD, Hirotsugu Kurobe MD, PhD, Tamotsu Kanbara MD, Eiki Fujimoto MD, Takashi Kitaichi MD PhD, Hiroshi Fujita MD, Hitoshi Sogabe MD, PhD, Tetsuya Kitagawa MD, PhD
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Keywords: heparin-induced thrombocytopenia, aortic surgery, unfractionated heparin, heparin-platelet factor 4 complex, argatroban
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2013 Volume 60 Issue 1.2 Pages 154-158

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Abstract

An extremely rare case with delayed-onset heparin-induced thrombocytopenia (HIT) is described. A 46-year-old man underwent arch replacement for aortic dissection under cardiopulmonary bypass and initial exposure of unfractionated heparin. In post operative 7 days, persistent atrial fibrillation was occurred, so a continuous infusion of heparin (10000 IU/day) and Vitamine K antagonist (Warfarin) taking was started for preventing thrombosis. By 32 days after the operation, his platelet count had fallen (3×103/µL) and oral hematoma and ecchymoma of bilateral lower legs were occurred. The value of HIT antibodies and the IgG antibody was 2.485 and 1.586 on 32-postoperative day, respectively. Heparin was immediately discontinued, and argatroban administrated. Platelet exceeded above 100×103/µL on 12 days of the therapy. To our knowledge, few cases of delayed-onset severe HIT associated with CPB surgery have been reported in Japan. J. Med. Invest. 60: 154-158, February, 2013

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© 2013 by The University of Tokushima Faculty of Medicine
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