Heparin-Induced Venous and Arterial Thromboembolic Disease: Case Report and Literature Data

Abstract

HIT results from the development of F4P-specific IgG antibodies. It usually begins 5-14 days after initiation of heparin therapy with a drop in platelet count of more than 50% from a pretreatment value, associated in one in two patients with venous and/or arterial thrombotic complications. This is a rarer problem that occurs in 1-5% with UFH and 0.1-0.2% with LMWH and requires prompt management. Forty-seven-year-old patient, alcoholic at 3g/d for 10 years, hospitalized for APO complicating an ethylic CMD, LVEF 33% in tachy ACFA at 150batt/min. The patient was treated with furosemide and risordan. Injectable Cordarone was administered and LMWH in curative dose for 7 days. The evolution was marked by a resumption of sinus rhythm, disappearance of crepitus rales, after one week, but an installation of thrombenia at 22000/mm3, a pulmonary embolism, left popliteal DVT and thrombosis of the iliac and then left femoral arteries. The diagnosis of HIT type 2 was confirmed by the presence of anti-PF4 antibodies in association with the platelet activation test. LMWH was stopped, the patient received Fondaparinux 7.5mg/d until platelets normalized after 10 days and then substituted with rivaroxaban for 6 months after clinical improvement and normalization of arteriovenous Doppler ultrasound and chest angioscan.