Abu Kar Sarah, Kaur Amandeep, Khan Ahmed M, Bloomfield Dennis
Internal Medicine, Richmond University Medical Center, Staten Island, USA.
Hematology and Oncology, Richmond University Medical Center, Staten Island, USA.
Cureus. 2022 Mar 15;14(3):e23202. doi: 10.7759/cureus.23202. eCollection 2022 Mar.
We present a case of a 28-year-old diabetic female who presented with high-burden lower extremity deep vein thrombosis (DVT) after previous exposure to unfractionated heparin (UFH). Heparin was discontinued, and non-heparin parenteral anticoagulant, argatroban, was started based on a high clinical suspicion of heparin-induced thrombocytopenia with thrombosis (HITT). The diagnosis of HIT was later proven by positive immune and functional assays. The severity of thrombocytopenia and the need for surgical intervention to salvage the limb prompted the use of intravenous immunoglobulin (IVIG) early on in the treatment course to recover platelet counts, halt the prothrombotic state, and prepare the patient for thrombectomy. The patient was put on direct oral anticoagulants (DOACs), apixaban, after thrombectomy, and platelet count recovery with no new thrombosis or bleeding episodes was reported after three months of follow-up.
我们报告一例28岁的糖尿病女性患者，该患者在先前使用普通肝素（UFH）后出现了高负荷下肢深静脉血栓形成（DVT）。停用肝素后，基于高度临床怀疑肝素诱导的血小板减少伴血栓形成（HITT），开始使用非肝素胃肠外抗凝剂阿加曲班。HIT的诊断后来通过阳性免疫和功能检测得到证实。血小板减少的严重程度以及为挽救肢体而进行手术干预的必要性促使在治疗过程早期使用静脉注射免疫球蛋白（IVIG）以恢复血小板计数、阻止血栓前状态，并为患者进行血栓切除术做准备。患者在血栓切除术后开始使用直接口服抗凝剂（DOACs）阿哌沙班，随访三个月后报告血小板计数恢复，且无新的血栓形成或出血事件。
