Nasuno Akimitsu, Matsubara Taku, Hori Tomoyuki, Higuchi Kotaro, Tsuchida Keiichi, Mezaki Tohru, Tanaka Takayuki, Hanzawa Kazuhiro, Moro Hisanaga, Hayashi Jun-ichi, Tanaka Ken-ichi, Fuse Ichiro, Aizawa Yoshifusa
First Department of Internal Medicine, Niigata University Medical Hospital, Japan.
Circ J. 2003 Jan;67(1):96-8. doi: 10.1253/circj.67.96.
Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) is a potentially life-threatening side effect of heparin therapy, triggered by an immune response, and has been reported to be related not only to the therapeutic use of heparin but also to heparin-coated catheters. A 45-year-old woman with intrapelvic malignancy developed an acute pulmonary thromboembolism (PE) after hysterectomy despite prophylactic heparin use. Subsequent large doses of heparin for treatment of the PE exacerbated the thrombocytopenia and, moreover, a large thrombus formed around the heparin-coated central venous catheter. Anti-heparin-platelet factor 4 complex antibody and heparin-induced platelet aggregation assay were positive, so the diagnosis was HITTS, and heparin was replaced by argatroban after carrying out thrombectomy. This therapy was successful, and the patient made favorable progress.
